1780074286 NPI number — BLUE RIDGE ON THE MOUNTAIN LLC

Table of content: HAYLEY TAYLOR DAVIS PHARMD (NPI 1114545514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780074286 NPI number — BLUE RIDGE ON THE MOUNTAIN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLUE RIDGE ON THE MOUNTAIN LLC
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:
1780074286
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
417 MOUNTAIN TRACE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYLVA
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28779-6779
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-631-1600
Provider Business Mailing Address Fax Number:
828-631-1648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
417 MOUNTAIN TRACE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYLVA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28779-6779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-631-1600
Provider Business Practice Location Address Fax Number:
828-631-1648
Provider Enumeration Date:
02/04/2015

Additional Information

Authorized Official

Authorized Official Last Name:
RUDD
Authorized Official First Name:
LEVI
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
786-358-5200

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com