Provider Demographics
NPI:1235134123
Name:RIVERSIDE TAPPAHANNOCK HOSPITAL INC
Entity Type:Organization
Organization Name:RIVERSIDE TAPPAHANNOCK HOSPITAL INC
Other - Org Name:RIVERSIDE TAPPAHANNOCK HOSP HHA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF HOME HEALTH
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-594-4600
Mailing Address - Street 1:PO BOX 120014
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23612-0014
Mailing Address - Country:US
Mailing Address - Phone:757-594-4600
Mailing Address - Fax:757-594-3386
Practice Address - Street 1:856 J CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1318
Practice Address - Country:US
Practice Address - Phone:804-443-6276
Practice Address - Fax:804-443-6275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA497025B251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4970250Medicaid
VA4970250Medicaid