Provider Demographics
NPI:1154051639
Name:THEDAVISFAM, LLC
Entity Type:Organization
Organization Name:THEDAVISFAM, LLC
Other - Org Name:BLUEGRASS NATURAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD NM, CFMP, RNFA
Authorized Official - Phone:714-393-5840
Mailing Address - Street 1:1031 WELLINGTON WAY STE 245
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1256
Mailing Address - Country:US
Mailing Address - Phone:714-393-5840
Mailing Address - Fax:
Practice Address - Street 1:1031 WELLINGTON WAY STE 245
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1256
Practice Address - Country:US
Practice Address - Phone:714-393-5840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty