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General NPI Number Information
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NPI Number | 1659778819
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Entity Type | Organization
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Legal Business Name | INDEPENDENCE ASSISTANCE SERVICES OF THE BLUEGRASS
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 12/09/2014
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Provider Practice Location Address
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Address Line | 343 WALLER AVE SUITE 309
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City | LEXINGTON
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State | KY
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Zip | 40504-2912
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Country | US
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Telephone | 859-303-4040
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Fax | 859-317-9924
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Provider Business Mailing Address
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Address Line | 343 WALLER AVE SUITE 309
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City | LEXINGTON
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State | KY
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Zip | 40504-2912
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Country | US
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Telephone | 859-303-4040
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Fax | 859-317-9924
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Authorized Official
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Title or Position | COO
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Name | MR. CLELLAND R GASH
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Credential |
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Telephone | 859-303-4040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 500194
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License Number State | KY
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