MEDICARE: A VISION FOR YOU INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	177F00000X	Lodging Provider
3	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	811959	OTHER	KY	KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES - AODE

General Provider Information

NPI Number	:	1669241873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A VISION FOR YOU INC

Provider Business Mailing Address
First Line	:	1675 STORY AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40206-1739
Country	:	US
Telephone Number	:	502-749-6344
Fax Number	:

Provider Business Practice Location Address
First Line	:	1675 STORY AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40206-1739
Country	:	US
Telephone Number	:	502-749-6344
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & EXECUTIVE DIRECTOR
Name	:	MR. JOHNATHAN LUCAS BENNETT
Credential	:	CADCA I
Telephone Number	:	502-749-6344

Provider Enumeration Date	:	12/28/2023
Last Update Date	:	01/15/2026

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