Provider Demographics
NPI:1356593420
Name:BLUE RIDGE ADDICTION RECOVERY
Entity type:Organization
Organization Name:BLUE RIDGE ADDICTION RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:DEVIRGILIIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-263-8228
Mailing Address - Street 1:381 DEERFIELD RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5009
Mailing Address - Country:US
Mailing Address - Phone:828-263-8228
Mailing Address - Fax:828-263-8228
Practice Address - Street 1:381 DEERFIELD RD
Practice Address - Street 2:SUITE C
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5009
Practice Address - Country:US
Practice Address - Phone:828-263-8228
Practice Address - Fax:828-263-8228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder