Bluegrass Community Living, Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

BLUEGRASS COMMUNITY LIVING, INC.

Practice address

107 Broadbill Court
Georgetown, KY 40324-9294

Phone

(502) 570-9269

NPI assigned

May 3, 2007

Last updated

May 1, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Derran C. Broyles, OWNER

Title

Chief of Financial Affairs

Phone

(502) 570-9269

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209600000000",
    "number": "1184836272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 BROADBILL COURT",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403249294",
            "telephone_number": "502-570-9269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 BROADBILL COURT",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403249294",
            "telephone_number": "502-570-9269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEGRASS COMMUNITY LIVING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2008-05-01",
        "status": "A",
        "authorized_official_last_name": "BROYLES",
        "authorized_official_first_name": "DERRAN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "CHIEF OF FINANCIAL AFFAIRS",
        "authorized_official_telephone_number": "502-570-9269",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OWNER"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3300130600",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Bluegrass Community Care, Inc.
• Bluegrass Direct Primary Care
• Bluegrass Obstetrics & Gynecology
• Bluegrass Orthopaedics PSC (Bluegrass Orthopaedics)
• Bluegrass Pediatrics and Internal Medicine, PLLC
• Taylor Boggs, BSN, RN

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Georgetown, KY
• Providers in Georgetown, KY by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.