Healthcare Provider Details

I. General information

NPI: 1437137734
Provider Name (Legal Business Name): BLUE RIDGE BEHAVIORAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ELM AVE SW
ROANOKE VA
24016-4001
US

IV. Provider business mailing address

301 ELM AVE SW
ROANOKE VA
24016-4001
US

V. Phone/Fax

Practice location:
  • Phone: 540-345-9841
  • Fax: 540-527-2900
Mailing address:
  • Phone: 540-345-9841
  • Fax: 540-527-2900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. CYNTHIA J. VAUGHT
Title or Position: REIMBURSEMENT MANAGER
Credential:
Phone: 540-345-9841