Healthcare Provider Details

I. General information

NPI: 1215043732
Provider Name (Legal Business Name): RIVERSIDE CONVALESCENT CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 ALGONQUIN RD
HAMPTON VA
23661-1605
US

IV. Provider business mailing address

608 DENBIGH BLVD SUITE 600
NEWPORT NEWS VA
23608-4410
US

V. Phone/Fax

Practice location:
  • Phone: 757-722-9881
  • Fax: 757-723-3605
Mailing address:
  • Phone: 757-875-2023
  • Fax: 757-875-2016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH2666
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberNH2666
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberNH2666
License Number StateVA

VIII. Authorized Official

Name: MR. WALTER W AUSTIN
Title or Position: SENIOR VP, LTC
Credential:
Phone: 757-875-7846