Provider Demographics
NPI:1093175549
Name:BLUE RIDGE SENIOR HOUSING, LLC
Entity Type:Organization
Organization Name:BLUE RIDGE SENIOR HOUSING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUDSON
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-237-4509
Mailing Address - Street 1:3715 NORTHSIDE PKWY NW
Mailing Address - Street 2:BUILDING 300, SUITE 110
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2882
Mailing Address - Country:US
Mailing Address - Phone:404-237-4509
Mailing Address - Fax:404-237-1719
Practice Address - Street 1:3715 NORTHSIDE PKWY NW
Practice Address - Street 2:BUILDING 300, SUITE 110
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2882
Practice Address - Country:US
Practice Address - Phone:404-237-4509
Practice Address - Fax:404-237-1719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility