Provider Demographics
NPI:1619134418
Name:BLUE RIDGE COMMUNITY ACTION INC
Entity Type:Organization
Organization Name:BLUE RIDGE COMMUNITY ACTION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-438-6255
Mailing Address - Street 1:800 N GREEN ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-5610
Mailing Address - Country:US
Mailing Address - Phone:828-438-6255
Mailing Address - Fax:828-433-5721
Practice Address - Street 1:800 N GREEN ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-5610
Practice Address - Country:US
Practice Address - Phone:828-438-6255
Practice Address - Fax:828-433-5721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8600115Medicaid