Provider Demographics
NPI:1649328378
Name:BLUEGRASS COMMUNITY CARE, INC.
Entity type:Organization
Organization Name:BLUEGRASS COMMUNITY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:TROYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-867-7177
Mailing Address - Street 1:207 AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9533
Mailing Address - Country:US
Mailing Address - Phone:502-867-7177
Mailing Address - Fax:502-867-7179
Practice Address - Street 1:207 AUGUSTA DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9533
Practice Address - Country:US
Practice Address - Phone:502-867-7177
Practice Address - Fax:502-867-7179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY33000852Medicaid