Provider Demographics
NPI:1225029051
Name:BLUE RIDGE COMMUNITY HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:BLUE RIDGE COMMUNITY HEALTH SERVICES, INC.
Other - Org Name:BLUE RIDGE COMMUNITY HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDSPETH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-692-4289
Mailing Address - Street 1:PO BOX 5151
Mailing Address - Street 2:2579 CHIMNEY ROCK ROAD
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28793-5151
Mailing Address - Country:US
Mailing Address - Phone:828-692-4289
Mailing Address - Fax:828-692-4396
Practice Address - Street 1:2579 CHIMNEY ROCK RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-9181
Practice Address - Country:US
Practice Address - Phone:828-692-4289
Practice Address - Fax:828-692-4396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC344556AMedicaid
NC0147GOtherBCBS IDENTIFIER
NC344556CMedicaid
NC344556DMedicaid
NC344556DMedicaid
NC341831Medicare PIN