Provider Demographics
NPI:1861838419
Name:BLUEGRASS THERAPY GROUP, LLC
Entity Type:Organization
Organization Name:BLUEGRASS THERAPY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/SLP
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:VAN KERSEN
Authorized Official - Last Name:FRANZINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-776-1450
Mailing Address - Street 1:1471 TWILIGHT TRL STE A
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-8497
Mailing Address - Country:US
Mailing Address - Phone:606-776-1450
Mailing Address - Fax:502-352-2967
Practice Address - Street 1:1471 TWILIGHT TRL STE A
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-8497
Practice Address - Country:US
Practice Address - Phone:606-776-1450
Practice Address - Fax:502-352-2967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYGN-771Medicaid
KYGN-773Medicaid