=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801891023
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIVERSIDE HOSPITAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2005
-----------------------------------------------------
Last Update Date | 08/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 856 J CLYDE MORRIS BLVD STE C
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23601-1318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-594-4600
-----------------------------------------------------
Fax | 757-594-3386
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 608 DENBIGH BLVD STE 800
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23608-4487
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-875-7545
-----------------------------------------------------
Fax | 757-875-7553
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SR VP/CFO
-----------------------------------------------------
Name | MR. WALTER W AUSTIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 757-875-7545
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 497467A
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------