Provider Demographics
NPI:1215043732
Name:RIVERSIDE CONVALESCENT CENTERS, INC.
Entity type:Organization
Organization Name:RIVERSIDE CONVALESCENT CENTERS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP, LTC
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:W
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-875-7846
Mailing Address - Street 1:608 DENBIGH BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-4410
Mailing Address - Country:US
Mailing Address - Phone:757-875-2023
Mailing Address - Fax:757-875-2016
Practice Address - Street 1:414 ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23661-1605
Practice Address - Country:US
Practice Address - Phone:757-722-9881
Practice Address - Fax:757-723-3605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2666313M00000X, 314000000X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004953088Medicaid
VA004953088Medicaid
VA1196040001Medicare NSC