Healthcare Provider Details

I. General information

NPI: 1184760795
Provider Name (Legal Business Name): BLUE RIDGE HEALTHCARE HOSPITALS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 PERKINS RD SE
VALDESE NC
28690-9403
US

IV. Provider business mailing address

298 PERKINS RD SE
VALDESE NC
28690-9403
US

V. Phone/Fax

Practice location:
  • Phone: 828-580-5464
  • Fax: 828-874-2679
Mailing address:
  • Phone: 828-580-5464
  • Fax: 828-874-2679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number08253
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RON FULMER
Title or Position: PHARMACY MANAGER
Credential: BS
Phone: 828-580-5464