Healthcare Provider Details

I. General information

NPI: 1235399643
Provider Name (Legal Business Name): BLUEGRASS MENTAL HEALTH AND MENTAL RETARDATION BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3161 CUSTER DR STE. 4
LEXINGTON KY
40517-4067
US

IV. Provider business mailing address

3161 CUSTER DR STE. 4
LEXINGTON KY
40517-4067
US

V. Phone/Fax

Practice location:
  • Phone: 859-271-9448
  • Fax: 859-272-6893
Mailing address:
  • Phone: 859-271-9448
  • Fax: 859-272-6893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ABEER MICHELLE BATEH
Title or Position: INITIAL SERVICE COORDINATOR
Credential: B.A.
Phone: 859-271-9448