Organization
RIVERSIDE BUILDERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES J FELTS II (PRESIDENT)
(804) 837-1771
Entity
Organization
Contact information
Practice address
130 SWIFT CREEK LN, COLONIAL HEIGHTS, VA 23834-1631
(804) 837-1771
Mailing address
130 SWIFT CREEK LN, COLONIAL HEIGHTS, VA 23834-1631
(804) 837-1771
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
2705085777
VA
332BC3200X
Customized Equipment (DME)
2705085777
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
570018379016
—
VA
Enumeration date
07/06/2018
Last updated
07/06/2018
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