Healthcare Provider Details

I. General information

NPI: 1245765783
Provider Name (Legal Business Name): LTACH AT RIVERSIDE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2017
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
US

IV. Provider business mailing address

4714 GETTYSBURG RD LEGAL DEPT
MECHANICSBURG PA
17055-4325
US

V. Phone/Fax

Practice location:
  • Phone: 717-972-1100
  • Fax:
Mailing address:
  • Phone: 717-972-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN DUGGAN
Title or Position: VICE PRESIDENT
Credential:
Phone: 717-972-1100