Healthcare Provider Details

I. General information

NPI: 1790784312
Provider Name (Legal Business Name): HOSPICE OF SOUTHERN KENTUCKY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5872 SCOTTSVILLE RD
BOWLING GREEN KY
42104-7853
US

IV. Provider business mailing address

5872 SCOTTSVILLE RD
BOWLING GREEN KY
42104-7853
US

V. Phone/Fax

Practice location:
  • Phone: 270-746-9300
  • Fax: 270-782-3496
Mailing address:
  • Phone: 270-746-9300
  • Fax: 270-782-3496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number400006
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. STEVEN JANTZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 270-746-9300