Healthcare Provider Details

I. General information

NPI: 1508708694
Provider Name (Legal Business Name): BLUEGRASS SERVICES OF KY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 08/09/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 LYNNWOOD DR
MT WASHINGTON KY
40047-7055
US

IV. Provider business mailing address

176 LYNNWOOD DR
MT WASHINGTON KY
40047-7055
US

V. Phone/Fax

Practice location:
  • Phone: 502-428-6361
  • Fax:
Mailing address:
  • Phone: 502-428-6361
  • Fax: 502-428-6361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: JAMES TOLLIVER
Title or Position: PESIDENT/CEO
Credential: OWNER
Phone: 502-428-6361