MEDICARE: NEW VISTA OF THE BLUEGRASS

Medicare Provider Information

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

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	091018	OTHER	KY	VALUE OPTIONS
2	000000057414	OTHER	KY	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	203628000	OTHER	KY	MAGELLAN 221
5	101483	OTHER	KY	CHA INSURANCE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	242395	OTHER	KY	COMPSYCH
10	207023	OTHER	KY	MHN
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	874068	OTHER	KY	USA

NPI Number	:	1366482317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW VISTA OF THE BLUEGRASS

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	:	1351 NEWTOWN PIKE
Second Line	:	BLDG 5
City	:	LEXINGTON
State	:	KY
Zip	:	40511-1275
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