Provider Demographics
NPI:1114315447
Name:SHORE HEALTH SERVICES INC
Entity Type:Organization
Organization Name:SHORE HEALTH SERVICES INC
Other - Org Name:RIVERSIDE HOSPICE-SMITHFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:W
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:757-875-7545
Mailing Address - Street 1:608 DENBIGH BOULEVARD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-4487
Mailing Address - Country:US
Mailing Address - Phone:757-875-7545
Mailing Address - Fax:
Practice Address - Street 1:23379 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:ACCOMAC
Practice Address - State:VA
Practice Address - Zip Code:23301-1314
Practice Address - Country:US
Practice Address - Phone:757-789-5000
Practice Address - Fax:757-789-3556
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHORE HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-09
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA491616Medicare Oscar/Certification
VA4900375Medicaid