MEDICARE: BLUE RIDGE RECOVERY CENTER, 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
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1548119126
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE RIDGE RECOVERY CENTER, LLC

Provider Business Mailing Address
First Line	:	15813 72ND AVE FL 2
Second Line	:
City	:	FRESH MEADOWS
State	:	NY
Zip	:	11365-4100
Country	:	US
Telephone Number	:	716-819-0480
Fax Number	:	716-819-0476

Provider Business Practice Location Address
First Line	:	400 BLUE RIDGE ST
Second Line	:
City	:	MARTINSVILLE
State	:	VA
Zip	:	24112-7265
Country	:	US
Telephone Number	:	540-645-5839
Fax Number	:	540-645-5839

Authorized Official
Title or Position	:	CEO
Name	:	CHRISTOPHER FOSTER
Credential	:
Telephone Number	:	716-819-0392

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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