=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609143338
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLUE RIDGE SENIOR SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2011
-----------------------------------------------------
Last Update Date | 11/23/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1293 HENDERSONVILLE RD SUITE 4
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28803-1952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-274-4406
-----------------------------------------------------
Fax | 828-274-4106
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1293 HENDERSONVILLE RD SUITE 4
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28803-1952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-274-4406
-----------------------------------------------------
Fax | 828-274-4106
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | STEVEN COLEMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 828-274-4406
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HC3917
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------