| NPI | 1104032754 |
|---|---|
| Doing Business As | BLUE GRASS DEPOT AHC |
| Entity Type | Organization |
| Authorized Contact | BARBARA HORNBACK Ubo Manager 502-624-9870 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1100X Clinic/Center Military/U.S. Coast Guard Outpatient |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2015-04-01 |