Basic Information
| Provider Information | |||||||||
| NPI: | 1831468149 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BLUEGRASS MENTAL HEALTH AND MENTAL RETARDATION BOARD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1351 NEWTOWN PIKE | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405111275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8599876127 | ||||||||
| FaxNumber: | 8594730498 | ||||||||
| Practice Location | |||||||||
| Address1: | 269 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PARIS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403612126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8599876127 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2011 | ||||||||
| LastUpdateDate: | 12/16/2011 | ||||||||
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| AuthorizedOfficialLastName: | WARE | ||||||||
| AuthorizedOfficialFirstName: | SHANNON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8592531686 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 1288 | KY | Y | Agencies | Community/Behavioral Health |
No ID Information.