Healthcare Provider Details

I. General information

NPI: 1235134123
Provider Name (Legal Business Name): RIVERSIDE TAPPAHANNOCK HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

856 J CLYDE MORRIS BLVD SUITE C
NEWPORT NEWS VA
23601-1318
US

IV. Provider business mailing address

PO BOX 120014
NEWPORT NEWS VA
23612-0014
US

V. Phone/Fax

Practice location:
  • Phone: 804-443-6276
  • Fax: 804-443-6275
Mailing address:
  • Phone: 757-594-4600
  • Fax: 757-594-3386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number497025B
License Number StateVA

VIII. Authorized Official

Name: MRS. VICKIE MORGAN
Title or Position: DIRECTOR OF HOME HEALTH
Credential: RN
Phone: 757-594-4600