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General NPI Number Information
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NPI Number | 1770516148
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE RESIDENTIAL SERVICES, LLC
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 828 MAIN ST SUITE 1103
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City | LYNCHBURG
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State | VA
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Zip | 24504-1500
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Country | US
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Telephone | 434-316-9112
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Fax | 434-316-9244
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Provider Business Mailing Address
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Address Line | PO BOX 1159
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City | FOREST
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State | VA
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Zip | 24551-5159
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Country | US
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Telephone | 434-316-9112
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Fax | 434-316-9244
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | RICHARD GILMAN
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Credential |
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Telephone | 434-316-9112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 691
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License Number State | VA
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