MEDICARE: BLUE RIDGE COMMUNITY HEALTH SERVICES, INC

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1760950133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE RIDGE COMMUNITY HEALTH SERVICES, INC

Provider Business Mailing Address
First Line	:	PO BOX 5151
Second Line	:
City	:	HENDERSONVILLE
State	:	NC
Zip	:	28793-5151
Country	:	US
Telephone Number	:	828-692-4289
Fax Number	:	828-696-1794

Provider Business Practice Location Address
First Line	:	321 WOLVERINE TRL
Second Line	:
City	:	MILL SPRING
State	:	NC
Zip	:	28756-5821
Country	:	US
Telephone Number	:	828-692-4289
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF PFS
Name	:	BELINDA ELMORE
Credential	:
Telephone Number	:	828-692-4289

Provider Enumeration Date	:	11/05/2018
Last Update Date	:	11/05/2018

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