Provider Demographics
NPI:1154064319
Name:BLUEGRASS ELITE HEALTHCARE, INC.
Entity Type:Organization
Organization Name:BLUEGRASS ELITE HEALTHCARE, INC.
Other - Org Name:ALLIED CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO / DIRECTOR OF MISSIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:CAIN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:606-471-9423
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-0003
Mailing Address - Country:US
Mailing Address - Phone:606-291-7011
Mailing Address - Fax:866-948-3657
Practice Address - Street 1:3453 KY HWY 2565
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-5005
Practice Address - Country:US
Practice Address - Phone:606-291-7011
Practice Address - Fax:606-483-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-15
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty