Healthcare Provider Details

I. General information

NPI: 1083852586
Provider Name (Legal Business Name): RIVERSIDE HEALTHCARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 J CLYDE MORRIS BLVD
NEWPORT NEWS VA
23601-1303
US

IV. Provider business mailing address

608 DENBIGH BLVD STE 800
NEWPORT NEWS VA
23608-4410
US

V. Phone/Fax

Practice location:
  • Phone: 757-594-3944
  • Fax: 757-534-6330
Mailing address:
  • Phone: 757-875-7545
  • Fax: 757-875-7553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number0201003424
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0201003424
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number0201003424
License Number StateVA

VIII. Authorized Official

Name: MIKE BOGGS
Title or Position: ADMINISTRATOR
Credential:
Phone: 757-594-4600