Provider Demographics
NPI:1700905510
Name:BLUE RIDGE HOME CARE
Entity type:Organization
Organization Name:BLUE RIDGE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-530-7700
Mailing Address - Street 1:PO BOX 532588
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-2588
Mailing Address - Country:US
Mailing Address - Phone:843-821-8525
Mailing Address - Fax:843-821-0982
Practice Address - Street 1:2348 HIGHWAY 105 SOUTH
Practice Address - Street 2:UNIT # 11
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-7802
Practice Address - Country:US
Practice Address - Phone:828-262-5656
Practice Address - Fax:828-262-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NC070235332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0355050007Medicare NSC