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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