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General NPI Number Information
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NPI Number | 1942533708
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Entity Type | Organization
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Legal Business Name | BLUERIDGE HEALTH SERVICES LLC
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Dates
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Enumeration Date | 09/11/2009
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Last Update Date | 09/11/2009
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Provider Practice Location Address
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Address Line | 9898 BISSONNET ST SUITE 530
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City | HOUSTON
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State | TX
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Zip | 77036-8270
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Country | US
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Telephone | 281-660-6991
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Fax | 713-271-5353
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Provider Business Mailing Address
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Address Line | 9898 BISSONNET ST SUITE 530
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City | HOUSTON
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State | TX
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Zip | 77036-8270
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Country | US
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Telephone | 281-660-6991
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Fax | 713-271-5353
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. LARRY BOJE
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Credential |
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Telephone | 281-660-6991
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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 |
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License Number State |
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