Provider Demographics
NPI:1033002670
Name:BLUEGRASS PEER SUPPORTS
Entity type:Organization
Organization Name:BLUEGRASS PEER SUPPORTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEER SUPPORT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-762-6561
Mailing Address - Street 1:3533 LENTZ AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1818
Mailing Address - Country:US
Mailing Address - Phone:502-762-6561
Mailing Address - Fax:
Practice Address - Street 1:3533 LENTZ AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1818
Practice Address - Country:US
Practice Address - Phone:502-762-6561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty