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General NPI Number Information
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NPI Number | 1619689452
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Entity Type | Organization
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Legal Business Name | BLUE RIVER LLC
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Dates
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Enumeration Date | 12/22/2022
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Last Update Date | 12/22/2022
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Provider Practice Location Address
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Address Line | 1466 CHESTNUT KNOB RD
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City | MARTINSVILLE
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State | VA
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Zip | 24112-0161
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Country | US
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Telephone | 276-618-2793
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1158
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City | COLLINSVILLE
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State | VA
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Zip | 24078-1079
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANTE MORRIS
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Credential |
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Telephone | 276-618-2793
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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