Provider Demographics
NPI:1942533708
Name:BLUERIDGE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:BLUERIDGE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-660-6991
Mailing Address - Street 1:9898 BISSONNET ST
Mailing Address - Street 2:SUITE 530
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8270
Mailing Address - Country:US
Mailing Address - Phone:281-660-6991
Mailing Address - Fax:713-271-5353
Practice Address - Street 1:9898 BISSONNET ST
Practice Address - Street 2:SUITE 530
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8270
Practice Address - Country:US
Practice Address - Phone:281-660-6991
Practice Address - Fax:713-271-5353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities