Healthcare Provider Details

I. General information

NPI: 1346736014
Provider Name (Legal Business Name): RIVERSIDE BUILDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 SWIFT CREEK LN
COLONIAL HEIGHTS VA
23834-1631
US

IV. Provider business mailing address

130 SWIFT CREEK LN
COLONIAL HEIGHTS VA
23834-1631
US

V. Phone/Fax

Practice location:
  • Phone: 804-837-1771
  • Fax:
Mailing address:
  • Phone: 804-837-1771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number2705085777
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number2705085777
License Number StateVA

VIII. Authorized Official

Name: MR. CHARLES J FELTS II
Title or Position: PRESIDENT
Credential:
Phone: 804-837-1771