Healthcare Provider Details

I. General information

NPI: 1366482242
Provider Name (Legal Business Name): NEW VISTA OF THE BLUEGRASS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E OFFICE ST
HARRODSBURG KY
40330-1606
US

IV. Provider business mailing address

1351 NEWTOWN PIKE
LEXINGTON KY
40511-1275
US

V. Phone/Fax

Practice location:
  • Phone: 859-253-1686
  • Fax: 859-254-2743
Mailing address:
  • Phone: 859-253-1686
  • Fax: 859-254-2743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number800121
License Number StateKY

VIII. Authorized Official

Name: MS. DEE WERLINE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 859-253-1686