Provider Demographics
NPI:1780119180
Name:BLUEGRASS TRANSIT OF HARLAN
Entity type:Organization
Organization Name:BLUEGRASS TRANSIT OF HARLAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAROD
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:NUNNELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-273-5756
Mailing Address - Street 1:522 HIGHWAY 1137
Mailing Address - Street 2:
Mailing Address - City:CAWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40815-5233
Mailing Address - Country:US
Mailing Address - Phone:606-273-5756
Mailing Address - Fax:
Practice Address - Street 1:522 HIGHWAY 1137
Practice Address - Street 2:
Practice Address - City:CAWOOD
Practice Address - State:KY
Practice Address - Zip Code:40815-5233
Practice Address - Country:US
Practice Address - Phone:606-273-5756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)