Healthcare Provider Details

I. General information

NPI: 1134041031
Provider Name (Legal Business Name): BLUE RIDGE SUPPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 S MAIN ST
GALAX VA
24333-4409
US

IV. Provider business mailing address

1135 S MAIN ST
GALAX VA
24333-4409
US

V. Phone/Fax

Practice location:
  • Phone: 540-808-3380
  • Fax:
Mailing address:
  • Phone: 540-808-3380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DARA HICKS
Title or Position: MANAGING MEMBER
Credential:
Phone: 540-808-3380