Provider Demographics
NPI:1346580719
Name:NEW VISTA OF THE BLUEGRASS INC
Entity Type:Organization
Organization Name:NEW VISTA OF THE BLUEGRASS INC
Other - Org Name:BLUEGRASS.ORG
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:WERLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-253-1686
Mailing Address - Street 1:201 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40507-1086
Mailing Address - Country:US
Mailing Address - Phone:859-253-1686
Mailing Address - Fax:
Practice Address - Street 1:201 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40507-1086
Practice Address - Country:US
Practice Address - Phone:859-253-1686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY207023OtherMHN
242395OtherCOMPSYCH
KY000000057414OtherANTHEM
KY33900119Medicaid
KY270151015Medicaid
KY091018OtherVALUE OPTIONS
KY101483OtherCHA INSURANCE
KY1790731081Medicaid
KY20354400OtherMAGELLAN
KY28015014Medicaid
KY29000003Medicaid
874068OtherUSA
KY33900119Medicaid