Healthcare Provider Details

I. General information

NPI: 1801823828
Provider Name (Legal Business Name): BLUEGRASS REGIONAL PSYCHIATRIC SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 W FOURTH ST
LEXINGTON KY
40508-1294
US

IV. Provider business mailing address

627 W FOURTH ST
LEXINGTON KY
40508-1294
US

V. Phone/Fax

Practice location:
  • Phone: 859-246-7363
  • Fax: 859-246-7023
Mailing address:
  • Phone: 859-246-7363
  • Fax: 859-246-7023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: MRS. ERICA L ODUSANYA
Title or Position: FISCAL OFFICE MANAGER
Credential: M.H.A
Phone: 859-246-7363