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NPI Code Detail

MEDICARE: BLUE RIDGE OF RALEIGH LLC

MEDICARE: BLUE RIDGE OF RALEIGH LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilityNC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275532426
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUE RIDGE OF RALEIGH LLC
Provider Business Mailing Address
First Line : 3830 BLUE RIDGE RD
Second Line :
City : RALEIGH
State : NC
Zip : 27612-4319
Country : US
Telephone Number : 919-781-4900
Fax Number : 919-571-2583
Provider Business Practice Location Address
First Line : 3830 BLUE RIDGE RD
Second Line :
City : RALEIGH
State : NC
Zip : 27612-4319
Country : US
Telephone Number : 919-781-4900
Fax Number : 919-571-2583
Authorized Official
Title or Position : EXECUTIVE VP
Name : KEVIN BRESLIN
Credential :
Telephone Number : 201-242-4004
Provider Enumeration Date : 07/19/2005
Last Update Date : 02/14/2008

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Directions to “BLUE RIDGE OF RALEIGH LLC ” Practice Location

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