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Organization

RIVERSIDE RETIREMENT SERVICE, INC

Active
Parent organization
RIVERSIDE HEALTHCARE ASSOCIATION, INC
Other names
Riverside PACE
Organization subpart
Yes

Provider details

NPI number
Legal business name
RIVERSIDE HEALTHCARE ASSOCIATION, INC
Authorized official
CRAIG CONNORS (VP COMMUNITY BASED SERVICES)
(757) 875-2050
Entity
Organization

Contact information

Practice address
319 BROWN ST, PETERSBURG, VA 23803-4247
(757) 369-5137
Mailing address
1020 OLD DENBIGH BLVD, NEWPORT NEWS, VA 23602-2017
(757) 875-2050
(757) 875-2070

Taxonomy

Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
H8655
MEDICARE CONTRACT NUMBER
Enumeration date
11/15/2011
Last updated
11/15/2011
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