Provider Demographics
NPI:1255442570
Name:BLUE RIDGE BEHAVIORAL HEALTHCARE
Entity type:Organization
Organization Name:BLUE RIDGE BEHAVIORAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIKKEMA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-345-9841
Mailing Address - Street 1:2708 LIBERTY RD NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-4745
Mailing Address - Country:US
Mailing Address - Phone:540-344-4042
Mailing Address - Fax:540-344-1958
Practice Address - Street 1:2708 LIBERTY RD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-4745
Practice Address - Country:US
Practice Address - Phone:540-344-4042
Practice Address - Fax:540-344-1958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
VA0904004852251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services