Provider Demographics
NPI:1073796694
Name:RIVER CITY RESIDENCES, LLC
Entity Type:Organization
Organization Name:RIVER CITY RESIDENCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-307-6908
Mailing Address - Street 1:10201 DURYEA DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-1705
Mailing Address - Country:US
Mailing Address - Phone:804-323-5959
Mailing Address - Fax:804-323-5959
Practice Address - Street 1:10201 DURYEA DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1705
Practice Address - Country:US
Practice Address - Phone:804-323-5959
Practice Address - Fax:804-323-5959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA911-01001310500000X, 315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness