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General NPI Number Information
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NPI Number | 1346449451
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE NURSING, LLC
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 1263 S GEORGE ST
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City | CHARLES TOWN
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State | WV
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Zip | 25414-4384
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Country | US
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Telephone | 304-725-6575
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Fax |
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Provider Business Mailing Address
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Address Line | 10123 ALLIANCE RD
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City | BLUE ASH
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State | OH
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Zip | 45242-4887
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Country | US
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Telephone | 513-530-1808
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Fax |
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Authorized Official
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Title or Position | SECRETARY / TREASURER
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Name | CHARLES R STOLTZ
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Credential |
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Telephone | 513-530-1808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 25
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License Number State | WV
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