1215043732 NPI number — RIVERSIDE CONVALESCENT CENTERS, INC.

Table of content: (NPI 1215043732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215043732 NPI number — RIVERSIDE CONVALESCENT CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVERSIDE CONVALESCENT CENTERS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RIVERSIDE REHABILITATION CENTER AT HAMPTON
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215043732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
608 DENBIGH BLVD
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23608-4410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-875-2023
Provider Business Mailing Address Fax Number:
757-875-2016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
414 ALGONQUIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMPTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23661-1605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-722-9881
Provider Business Practice Location Address Fax Number:
757-723-3605
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AUSTIN
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
W
Authorized Official Title or Position:
SENIOR VP, LTC
Authorized Official Telephone Number:
757-875-7846

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  NH2666 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 314000000X , with the licence number: NH2666 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: NH2666 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004953088 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com