Healthcare Provider Details

I. General information

NPI: 1194632018
Provider Name (Legal Business Name): RIVERSIDE RETIREMENT SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 OLD DENBIGH BLVD
NEWPORT NEWS VA
23602-2017
US

IV. Provider business mailing address

608 DENBIGH BLVD STE 804
NEWPORT NEWS VA
23608-4458
US

V. Phone/Fax

Practice location:
  • Phone: 757-886-2200
  • Fax:
Mailing address:
  • Phone: 757-875-7846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: LINWOOD SHAWN NELSON
Title or Position: VP FINANCE / LLH CFO
Credential:
Phone: 757-875-7846