MEDICARE: BLUE RIDGE HEALTH SERVICES

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	251C00000X	Developmentally Disabled Services Day Training Agency	3409001	NC

Other Identifiers

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

General Provider Information

NPI Number	:	1982709622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE RIDGE HEALTH SERVICES

Provider Business Mailing Address
First Line	:	9 FAWNWOOD CT
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-6139
Country	:	US
Telephone Number	:	336-292-1597
Fax Number	:	336-292-1161

Provider Business Practice Location Address
First Line	:	7 DUNDAS CIR STE F
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1645
Country	:	US
Telephone Number	:	336-292-1597
Fax Number	:	336-292-1161

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. LUBNA SACHEDINA REECE
Credential	:
Telephone Number	:	336-292-1597

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	02/02/2012

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