Provider Demographics
NPI:1942481957
Name:FIRST AT BLUE RIDGE
Entity Type:Organization
Organization Name:FIRST AT BLUE RIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:828-337-0487
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:32 KNOX RD
Mailing Address - City:RIDGECREST
Mailing Address - State:NC
Mailing Address - Zip Code:28770-0040
Mailing Address - Country:US
Mailing Address - Phone:828-669-0011
Mailing Address - Fax:828-669-0589
Practice Address - Street 1:32 KNOX RD
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:NC
Practice Address - Zip Code:28770
Practice Address - Country:US
Practice Address - Phone:828-669-0011
Practice Address - Fax:828-669-0589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320800000X
NCMHL-011-264324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness