Healthcare Provider Details

I. General information

NPI: 1700867363
Provider Name (Legal Business Name): BLUE RIDGE COMMUNITY HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2579 CHIMNEY ROCK RD
HENDERSONVILLE NC
28792-9181
US

IV. Provider business mailing address

PO BOX 5151
HENDERSONVILLE NC
28793-5151
US

V. Phone/Fax

Practice location:
  • Phone: 828-692-7057
  • Fax: 828-696-8266
Mailing address:
  • Phone: 828-692-7057
  • Fax: 828-696-8266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: TONYA HARRIS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 828-692-4289