Organization
BLUEGRASS COMMUNITY LIVING, INC.
Active
Organization
BLUEGRASS COMMUNITY LIVING, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DERRAN C. BROYLES OWNER (CHIEF OF FINANCIAL AFFAIRS)
(502) 570-9269
Entity
Organization
Contact information
Practice address
107 BROADBILL COURT, GEORGETOWN, KY 40324-9294
(502) 570-9269
Mailing address
107 BROADBILL COURT, GEORGETOWN, KY 40324-9294
(502) 570-9269
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3300130600
—
KY
Enumeration date
05/03/2007
Last updated
05/01/2008
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