Provider Demographics
NPI:1487038766
Name:BLUEGRASS TRAINING AND THERAPY CENTER
Entity Type:Organization
Organization Name:BLUEGRASS TRAINING AND THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-939-0278
Mailing Address - Street 1:10214 PLAUDIT WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-3857
Mailing Address - Country:US
Mailing Address - Phone:502-933-7898
Mailing Address - Fax:502-933-7898
Practice Address - Street 1:10214 PLAUDIT WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-3857
Practice Address - Country:US
Practice Address - Phone:502-933-7898
Practice Address - Fax:502-933-7898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0811251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management