Provider Demographics
NPI:1841726817
Name:BLUEGRASS OAKWOOD
Entity type:Organization
Organization Name:BLUEGRASS OAKWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QIDP/COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:IDLEWINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-677-4068
Mailing Address - Street 1:115 QUAIL RUN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-4851
Mailing Address - Country:US
Mailing Address - Phone:606-425-7121
Mailing Address - Fax:
Practice Address - Street 1:2441 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-2935
Practice Address - Country:US
Practice Address - Phone:606-677-4068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY127180320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities