Provider Demographics
NPI:1659778819
Name:INDEPENDENCE ASSISTANCE SERVICES OF THE BLUEGRASS
Entity Type:Organization
Organization Name:INDEPENDENCE ASSISTANCE SERVICES OF THE BLUEGRASS
Other - Org Name:IASBG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLELLAND
Authorized Official - Middle Name:R
Authorized Official - Last Name:GASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-303-4040
Mailing Address - Street 1:343 WALLER AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2912
Mailing Address - Country:US
Mailing Address - Phone:859-303-4040
Mailing Address - Fax:859-317-9924
Practice Address - Street 1:343 WALLER AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2912
Practice Address - Country:US
Practice Address - Phone:859-303-4040
Practice Address - Fax:859-317-9924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY500194253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care