1003384140 NPI number — BLUE RIDGE COMMUNITY HEALTH SERVICES, INC

Table of content: (NPI 1003384140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003384140 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:
Provider Other Organization Name Type Code:
6
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:
1003384140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27509
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-2027
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:
146 NESBITT RDG
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE LURE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28746-0057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-625-4400
Provider Business Practice Location Address Fax Number:
828-625-4455
Provider Enumeration Date:
11/07/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HUDSPETH
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
828-233-2284

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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