Provider Demographics
NPI:1700867363
Name:BLUE RIDGE COMMUNITY HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:BLUE RIDGE COMMUNITY HEALTH SERVICES, INC.
Other - Org Name:KATE B REYNOLDS CHILDREN'S CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-692-4289
Mailing Address - Street 1:PO BOX 5151
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28793-5151
Mailing Address - Country:US
Mailing Address - Phone:828-692-7057
Mailing Address - Fax:828-696-8266
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:828-692-7057
Practice Address - Fax:828-696-8266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Single Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC344556DMedicaid
NC0147GOtherBCBS
NC344556AMedicaid
NC344556CMedicaid
NC341833Medicare ID - Type Unspecified