Provider Demographics
NPI:1790731081
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/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 1:1351 NEWTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1217
Mailing Address - Country:US
Mailing Address - Phone:859-253-1686
Mailing Address - Fax:859-254-2743
Practice Address - Street 1:191 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4101
Practice Address - Country:US
Practice Address - Phone:859-253-1686
Practice Address - Fax:859-254-2743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QC1500X
KY800121261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY242395OtherCOMPSYCH
KY270151015Medicaid
KY28015014Medicaid
KY29000003Medicaid
KY261QC1500XMedicaid
KY101483OtherCHA INSURANCE
KY30615058Medicaid
KY000000057414OtherANTHEM
KY874068OtherUSA
KY203544000OtherMAGELLAN 111
KY091018OtherVALUE OPTIONS
KY207023OtherMHN
KY33900119Medicaid