MEDICARE: HERITAGE PALLIATIVE SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1831546886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERITAGE PALLIATIVE SERVICES, INC.

Provider Business Mailing Address
First Line	:	120 ENTERPRISE DR
Second Line	:
City	:	DANVILLE
State	:	KY
Zip	:	40422-1870
Country	:	US
Telephone Number	:	859-236-2425
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 ENTERPRISE DR
Second Line	:
City	:	DANVILLE
State	:	KY
Zip	:	40422-1870
Country	:	US
Telephone Number	:	859-236-2425
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. NANCY JANELLE WHEELER
Credential	:	LCSW
Telephone Number	:	859-236-2425

Provider Enumeration Date	:	05/19/2016
Last Update Date	:	05/19/2016

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