Healthcare Provider Details

I. General information

NPI: 1073571865
Provider Name (Legal Business Name): LTACH AT RIVERSIDE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 J CLYDE MORRIS BLVD 4TH FLOOR EAST AND 4TH FLOOR ANNEX
NEWPORT NEWS VA
23601-1929
US

IV. Provider business mailing address

4714 GETTYSBURG RD LEGAL DEPT
MECHANICSBURG PA
17055-4325
US

V. Phone/Fax

Practice location:
  • Phone: 757-928-8261
  • Fax: 757-928-8271
Mailing address:
  • Phone: 717-975-4503
  • Fax: 717-975-9981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License NumberH1925
License Number StateVA

VIII. Authorized Official

Name: MR. JOHN DUGGAN JR.
Title or Position: VP
Credential:
Phone: 717-972-1100