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Organization
SHORE LIFECARE, INC.
Active
Organization
SHORE LIFECARE, INC.
Active
Other names
Riverside Shore Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
WALTER WILLIAM AUSTIN JR. (SR VP/CFO/TREASURER)
(757) 531-7015
Entity
Organization
Contact information
Practice address
26181 PARKSLEY RD, PARKSLEY, VA 23421-3723
(757) 665-5133
(757) 665-5136
Mailing address
608 DENBIGH BLVD STE 600, NEWPORT NEWS, VA 23608-4411
(757) 875-2023
(757) 875-2016
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
NH2475
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004953347
—
VA
01
—
1273950001
DURABLE MED EQUIPMENT
VA
Enumeration date
05/11/2006
Last updated
01/26/2021
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