Healthcare Provider Details

I. General information

NPI: 1124673587
Provider Name (Legal Business Name): BLUEGRASS COMPANION CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8911 THELMA LN
LOUISVILLE KY
40220-2939
US

IV. Provider business mailing address

8911 THELMA LN
LOUISVILLE KY
40220-2939
US

V. Phone/Fax

Practice location:
  • Phone: 502-709-5995
  • Fax:
Mailing address:
  • Phone: 502-709-5995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ARETTA DUNCAN
Title or Position: PRESIDENT
Credential:
Phone: 502-709-5995