Provider Demographics
NPI:1922632249
Name:BLUEGRASS BEHAVIORAL SCHOOL FOR CHILDREN
Entity Type:Organization
Organization Name:BLUEGRASS BEHAVIORAL SCHOOL FOR CHILDREN
Other - Org Name:BLUEGRASS BEHAVIORAL SERVICES FOR CHILDREN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:ISON
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-317-0802
Mailing Address - Street 1:1105 NATHANIEL CT
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-1069
Mailing Address - Country:US
Mailing Address - Phone:859-317-0802
Mailing Address - Fax:
Practice Address - Street 1:205 CHAMPION WAY STE 11
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-8862
Practice Address - Country:US
Practice Address - Phone:502-603-0020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health