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General NPI Number Information
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NPI Number | 1891871711
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE ELDERCARE, PC
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 59 E WEAVER AVE
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City | HARRISONBURG
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State | VA
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Zip | 22801-3047
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Country | US
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Telephone | 540-434-6354
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Fax |
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Provider Business Mailing Address
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Address Line | 59 E WEAVER AVE
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City | HARRISONBURG
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State | VA
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Zip | 22801-3047
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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 | PRESIDENT
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Name | JEFFREY L LANDIS
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Credential | L.C.S.W., D.C.S.W.
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Telephone | 540-434-6354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904001685
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License Number State | VA
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