Provider Demographics
NPI:1699208959
Name:BLUE RIDGE HEALTHCARE OF BUCHANAN LLC
Entity Type:Organization
Organization Name:BLUE RIDGE HEALTHCARE OF BUCHANAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-358-5200
Mailing Address - Street 1:2700 N 29TH AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-1520
Mailing Address - Country:US
Mailing Address - Phone:786-358-5200
Mailing Address - Fax:786-664-3311
Practice Address - Street 1:144 DEPOT ST
Practice Address - Street 2:
Practice Address - City:BUCHANAN
Practice Address - State:GA
Practice Address - Zip Code:30113-5216
Practice Address - Country:US
Practice Address - Phone:770-646-5512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility