Healthcare Provider Details

I. General information

NPI: 1982709622
Provider Name (Legal Business Name): BLUE RIDGE HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 DUNDAS CIR STE F
GREENSBORO NC
27407-1645
US

IV. Provider business mailing address

9 FAWNWOOD CT
GREENSBORO NC
27407-6139
US

V. Phone/Fax

Practice location:
  • Phone: 336-292-1597
  • Fax: 336-292-1161
Mailing address:
  • Phone: 336-292-1597
  • Fax: 336-292-1161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number3409001
License Number StateNC

VIII. Authorized Official

Name: MRS. LUBNA SACHEDINA REECE
Title or Position: PRESIDENT
Credential:
Phone: 336-292-1597