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General NPI Number Information
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NPI Number | 1184592701
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Entity Type | Organization
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Legal Business Name | BLUEGRASS ADVANCED MENTAL HEALTH, LLC.
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Dates
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Enumeration Date | 10/27/2025
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 4642 CHAMBERLAIN LN
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City | LOUISVILLE
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State | KY
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Zip | 40241-2156
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Country | US
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Telephone | 502-208-9003
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Fax |
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Provider Business Mailing Address
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Address Line | 8222 SPRING GLADE PL
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City | PROSPECT
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State | KY
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Zip | 40059-7653
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Country | US
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Telephone | 808-741-3031
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID ERICH ROTH
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Credential |
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Telephone | 808-741-3031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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