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NPI Code Detail

MEDICARE: HERITAGE HOSPICE, INC.

MEDICARE: HERITAGE HOSPICE, 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
1207QH0002XHospice and Palliative Medicine (Family Medicine) Physician400010KY
2364SA2100XAcute Care Clinical Nurse Specialist400010KY
3364SA2200XAdult Health Clinical Nurse Specialist400010KY
4364SC2300XChronic Care Clinical Nurse Specialist400010KY
5364SG0600XGerontology Clinical Nurse Specialist400010KY
6364SL0600XLong-Term Care Clinical Nurse Specialist400010KY
7251G00000XCommunity Based Hospice Care Agency400010KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000175142OTHERKYPROVIDER NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861495954
Entity Type Code : Organization
Provider Name (Legal Business Name) : HERITAGE HOSPICE, INC.
Provider Business Mailing Address
First Line : PO BOX 1213
Second Line :
City : DANVILLE
State : KY
Zip : 40423-1213
Country : US
Telephone Number : 859-236-2425
Fax Number : 859-236-6152
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 : 859-236-6152
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MS. JANELLE LANE WHEELER
Credential : L.C.S.W.
Telephone Number : 859-236-2425
Provider Enumeration Date : 05/23/2005
Last Update Date : 02/07/2017

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