Provider Demographics
NPI:1982709622
Name:BLUE RIDGE HEALTH SERVICES
Entity type:Organization
Organization Name:BLUE RIDGE HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUBNA
Authorized Official - Middle Name:SACHEDINA
Authorized Official - Last Name:REECE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-292-1597
Mailing Address - Street 1:9 FAWNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-6139
Mailing Address - Country:US
Mailing Address - Phone:336-292-1597
Mailing Address - Fax:336-292-1161
Practice Address - Street 1:7 DUNDAS CIR STE F
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1645
Practice Address - Country:US
Practice Address - Phone:336-292-1597
Practice Address - Fax:336-292-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3409001251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409001Medicaid