1366482317 NPI number — NEW VISTA OF THE BLUEGRASS

Table of content: (NPI 1366482317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366482317 NPI number — NEW VISTA OF THE BLUEGRASS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW VISTA OF THE BLUEGRASS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BLUEGRASS.ORG INC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366482317
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1351 NEWTOWN PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40511-1275
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-253-1686
Provider Business Mailing Address Fax Number:
859-254-2743

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1351 NEWTOWN PIKE
Provider Second Line Business Practice Location Address:
BLDG 5
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40511-1275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-253-1686
Provider Business Practice Location Address Fax Number:
859-254-2743
Provider Enumeration Date:
06/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WERLINE
Authorized Official First Name:
DEE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
859-253-1686

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  800121 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 091018 . This is a "VALUE OPTIONS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000057414 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 28015014 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 203628000 . This is a "MAGELLAN 221" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 101483 . This is a "CHA INSURANCE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 27015015 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29000003 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33900119 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 242395 . This is a "COMPSYCH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 207023 . This is a "MHN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 30615058 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 874068 . This is a "USA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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