Provider Demographics
NPI:1851777130
Name:BRNURSCO LLC
Entity Type:Organization
Organization Name:BRNURSCO LLC
Other - Org Name:BLUE RIDGE REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MIS
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORENE
Authorized Official - Middle Name:MARQUESS
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-659-4900
Mailing Address - Street 1:1400 CENTREPARK BLVD STE 810
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-7412
Mailing Address - Country:US
Mailing Address - Phone:239-963-3400
Mailing Address - Fax:239-963-3410
Practice Address - Street 1:300 BLUE RIDGE ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-7261
Practice Address - Country:US
Practice Address - Phone:276-638-8701
Practice Address - Fax:276-638-2017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility