Provider Demographics
NPI:1306843651
Name:BLUE RIDGE HOSPICE INC.
Entity Type:Organization
Organization Name:BLUE RIDGE HOSPICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-313-9244
Mailing Address - Street 1:333 W CORK ST
Mailing Address - Street 2:#405
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3870
Mailing Address - Country:US
Mailing Address - Phone:540-313-9200
Mailing Address - Fax:540-678-0772
Practice Address - Street 1:333 W CORK ST
Practice Address - Street 2:#405
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3870
Practice Address - Country:US
Practice Address - Phone:540-313-9200
Practice Address - Fax:540-678-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA050315251G00000X
VA1103813310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA19648OtherOPTIMA/SENTARA
VA4504289OtherAETNA PPO
VA2553033OtherAETNA HMO
VA337452OtherANTHEM BCBS PROVIDER NUMB
VA004915089Medicaid
VA7297911OtherCIGNA
VA7297911OtherCIGNA
VA7297911OtherCIGNA