Basic Information
| Provider Information | |||||||||
| NPI: | 1790731081 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEW VISTA OF THE BLUEGRASS INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BLUEGRASS.ORG | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1351 NEWTOWN PIKE | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405111217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592531686 | ||||||||
| FaxNumber: | 8592542743 | ||||||||
| Practice Location | |||||||||
| Address1: | 191 DOCTORS DR | ||||||||
| Address2: | |||||||||
| City: | FRANKFORT | ||||||||
| State: | KY | ||||||||
| PostalCode: | 406014101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592531686 | ||||||||
| FaxNumber: | 8592542743 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 11/22/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WERLINE | ||||||||
| AuthorizedOfficialFirstName: | DEE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8592531686 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | N | Ambulatory Health Care Facilities | Clinic/Center | Community Health | 261QM0801X | 800121 | KY | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 242395 | 01 | KY | COMPSYCH | OTHER | 270151015 | 05 | KY | MEDICAID | 28015014 | 05 | KY | MEDICAID | 29000003 | 05 | KY | MEDICAID | 261QC1500X | 05 | KY | MEDICAID | 101483 | 01 | KY | CHA INSURANCE | OTHER | 30615058 | 05 | KY | MEDICAID | 000000057414 | 01 | KY | ANTHEM | OTHER | 874068 | 01 | KY | USA | OTHER | 203544000 | 01 | KY | MAGELLAN 111 | OTHER | 091018 | 01 | KY | VALUE OPTIONS | OTHER | 207023 | 01 | KY | MHN | OTHER | 33900119 | 05 | KY | MEDICAID |