MEDICARE: BLUEGRASS TRAINING AND THERAPY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	0811	KY
2	251S00000X	Community/Behavioral Health Agency	0811	KY

General Provider Information

NPI Number	:	1487038766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEGRASS TRAINING AND THERAPY CENTER

Provider Business Mailing Address
First Line	:	10214 PLAUDIT WAY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40272-3857
Country	:	US
Telephone Number	:	502-933-7898
Fax Number	:	502-933-7898

Provider Business Practice Location Address
First Line	:	10214 PLAUDIT WAY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40272-3857
Country	:	US
Telephone Number	:	502-933-7898
Fax Number	:	502-933-7898

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MS. ERICA BOWEN
Credential	:
Telephone Number	:	502-939-0278

Provider Enumeration Date	:	07/16/2015
Last Update Date	:	07/16/2015

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