Provider Demographics
NPI:1851139125
Name:BLUEGRASS HEALTHCARE
Entity type:Organization
Organization Name:BLUEGRASS HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRA
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:WADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-889-7572
Mailing Address - Street 1:10300 CERULEAN SINKING FORK RD
Mailing Address - Street 2:
Mailing Address - City:CERULEAN
Mailing Address - State:KY
Mailing Address - Zip Code:42215-7406
Mailing Address - Country:US
Mailing Address - Phone:270-889-7572
Mailing Address - Fax:
Practice Address - Street 1:10300 CERULEAN SINKING FORK RD
Practice Address - Street 2:
Practice Address - City:CERULEAN
Practice Address - State:KY
Practice Address - Zip Code:42215-7406
Practice Address - Country:US
Practice Address - Phone:270-889-7572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100692720Medicaid