MEDICARE: NEW VISTA OF THE BLUEGRASS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	800121	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	203704000	OTHER	KY	MAGELLAN 225
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	207023	OTHER	KY	MHN
4	091018	OTHER	KY	VALUE OPTIONS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	874068	OTHER	KY	USA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	101483	OTHER	KY	CHA INSURANCE
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	000000057414	OTHER	KY	ANTHEM
11	242395	OTHER	KY	COMPSYCH
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043250095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW VISTA OF THE BLUEGRASS INC

Provider Business Mailing Address
First Line	:	1351 NEWTOWN PIKE
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40511-1275
Country	:	US
Telephone Number	:	859-253-1686
Fax Number	:	859-254-2743

Provider Business Practice Location Address
First Line	:	438 WASHINGTON ST
Second Line	:
City	:	STANTON
State	:	KY
Zip	:	40380-2048
Country	:	US
Telephone Number	:	859-253-1686
Fax Number	:	859-254-2743

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MS. DEE WERLINE
Credential	:
Telephone Number	:	859-253-1686

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	10/12/2020

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Directions to “NEW VISTA OF THE BLUEGRASS INC ” Practice Location

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