Provider Demographics
NPI:1801042866
Name:BLUE RIDGE HOME HEALTH CARE
Entity Type:Organization
Organization Name:BLUE RIDGE HOME HEALTH CARE
Other - Org Name:BLUE RIDGE HOME HEALTH CARE SERVICES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO / ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-236-1974
Mailing Address - Street 1:28 SHADETREE LN
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-6015
Mailing Address - Country:US
Mailing Address - Phone:276-236-1974
Mailing Address - Fax:276-236-1975
Practice Address - Street 1:28 SHADETREE LN
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-6015
Practice Address - Country:US
Practice Address - Phone:276-236-1974
Practice Address - Fax:276-236-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1801042866OtherPERSONAL CARE PROVIDER
VA1801042866Medicaid
VA1801042866OtherPERSONAL CARE PROVIDER