Provider Demographics
NPI:1972748044
Name:VALDESE GENERAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:VALDESE GENERAL HOSPITAL, INC.
Other - Org Name:BLUE RIDGE HEALTHCARE - LIFELINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:FRITTS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:828-580-5545
Mailing Address - Street 1:P.O. BOX 459
Mailing Address - Street 2:
Mailing Address - City:VALDESE
Mailing Address - State:NC
Mailing Address - Zip Code:28690
Mailing Address - Country:US
Mailing Address - Phone:828-580-6441
Mailing Address - Fax:828-580-6449
Practice Address - Street 1:201 ST. GERMAIN AVE S.W.
Practice Address - Street 2:
Practice Address - City:VALDESE
Practice Address - State:NC
Practice Address - Zip Code:28690
Practice Address - Country:US
Practice Address - Phone:828-580-6641
Practice Address - Fax:828-580-6449
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALDESE GENERAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408556Medicaid