Basic Information
| Provider Information | |||||||||
| NPI: | 1295069953 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTH HENDERSON STUDENT HEALTH | ||||||||
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| OtherOrganizationName: | BLUE RIDGE COMMUNITY HEALTH SERVICES, INC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5151 | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287935151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286924289 | ||||||||
| FaxNumber: | 8286961794 | ||||||||
| Practice Location | |||||||||
| Address1: | 35 FRUITLAND RD | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287928506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286924289 | ||||||||
| FaxNumber: | 8286961794 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2009 | ||||||||
| LastUpdateDate: | 06/20/2018 | ||||||||
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| AuthorizedOfficialLastName: | JARRETT | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF A/R | ||||||||
| AuthorizedOfficialTelephone: | 8286924289 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 133V00000X | N | 193200000X MULTI-SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered | 163WC1500X | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Community Health | 390200000X | Y | 193200000X MULTI-SPECIALTY GROUP | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.