1871811513 NPI number — BLUE RIDGE COMMUNITY HEALTH SERVICES INC

Table of content: (NPI 1871811513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871811513 NPI number — BLUE RIDGE COMMUNITY HEALTH SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLUE RIDGE COMMUNITY HEALTH SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BLUE RIDGE COMMUNITY HEALTH PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871811513
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5151
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSONVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28793-5151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-692-4289
Provider Business Mailing Address Fax Number:
828-696-1794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2579 CHIMNEY ROCK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28792-9181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-692-3102
Provider Business Practice Location Address Fax Number:
828-233-3399
Provider Enumeration Date:
05/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MORTON
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
BRIAN
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
828-692-4289

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 10518 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2125047 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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