Provider Demographics
NPI:1114603123
Name:BLUE RIDGE AUTISM CARE
Entity Type:Organization
Organization Name:BLUE RIDGE AUTISM CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:434-771-3457
Mailing Address - Street 1:PO BOX 493
Mailing Address - Street 2:
Mailing Address - City:KESWICK
Mailing Address - State:VA
Mailing Address - Zip Code:22947-0493
Mailing Address - Country:US
Mailing Address - Phone:434-771-3457
Mailing Address - Fax:
Practice Address - Street 1:210 CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:KESWICK
Practice Address - State:VA
Practice Address - Zip Code:22947-2109
Practice Address - Country:US
Practice Address - Phone:619-602-0965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-26
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty