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General NPI Number Information
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NPI Number | 1609390889
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE GROUP HOME
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Dates
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Enumeration Date | 07/31/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 11018 OLD STILLHOUSE RD
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City | BOSTON
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State | VA
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Zip | 22713-4031
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Country | US
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Telephone | 540-219-5110
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Fax |
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Provider Business Mailing Address
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Address Line | 11018 OLD STILLHOUSE RD
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City | BOSTON
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State | VA
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Zip | 22713-4031
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Country | US
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Telephone | 540-219-5110
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISA MCPHEARSON
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Credential |
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Telephone | 540-219-5110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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