| Blue Ridge Hope | |
|
131 W 2nd St Rutherfordton NC 28139-2448 | |
| (828) 202-3075 | |
| (828) 255-1968 |
| Full Name | Blue Ridge Hope |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 131 W 2nd St, Rutherfordton, North Carolina |
| Authorized Official Name and Position | Allyson Smith (ASSISTANT EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8284292221 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Ridge Hope 131 W 2nd St Rutherfordton NC 28139-2448 Ph: (828) 202-3075 | Blue Ridge Hope 131 W 2nd St Rutherfordton NC 28139-2448 Ph: (828) 202-3075 |
| NPI Number | 1104440726 |
|---|---|
| Provider Enumeration Date | 05/29/2020 |
| Last Update Date | 12/15/2023 |
| Certification Date | 12/15/2023 |
| Medicare PECOS PAC ID | 8921473190 |
|---|---|
| Medicare Enrollment ID | O20230401000035 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104440726 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Christian D Glover |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285128264 PECOS PAC ID: 0547510596 Enrollment ID: I20180912001999 |
| Provider Name | Joe Douglas Revis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174174601 PECOS PAC ID: 7517390818 Enrollment ID: I20191126003233 |
| Provider Name | Stephanie Lattimore |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417314378 PECOS PAC ID: 8022468958 Enrollment ID: I20240124000030 |
| Provider Name | Jerry Wease |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225373665 PECOS PAC ID: 5193174159 Enrollment ID: I20240218000101 |
| Provider Name | Michael Brian Taub |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1639308976 PECOS PAC ID: 5294184834 Enrollment ID: I20240226004020 |
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