Healthcare Provider Details

I. General information

NPI: 1497990857
Provider Name (Legal Business Name): RIVERSIDE RETIREMENT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 12/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GORDON AVE
RICHMOND VA
23224-7019
US

IV. Provider business mailing address

1020 OLD DENBIGH BLVD
NEWPORT NEWS VA
23602-2017
US

V. Phone/Fax

Practice location:
  • Phone: 804-549-5500
  • Fax: 757-549-5529
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. CRAIG CONNORS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 757-875-2050