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General NPI Number Information
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NPI Number | 1033002670
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Entity Type | Organization
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Legal Business Name | BLUEGRASS PEER SUPPORTS
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 3533 LENTZ AVE
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City | LOUISVILLE
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State | KY
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Zip | 40215-1818
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Country | US
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Telephone | 502-762-6561
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Fax |
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Provider Business Mailing Address
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Address Line | 3533 LENTZ AVE
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City | LOUISVILLE
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State | KY
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Zip | 40215-1818
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Country | US
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Telephone | 502-762-6561
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Fax |
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Authorized Official
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Title or Position | PEER SUPPORT SPECIALIST
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Name | KEVIN NELSON
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Credential |
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Telephone | 502-762-6561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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