Healthcare Provider Details

I. General information

NPI: 1861495954
Provider Name (Legal Business Name): HERITAGE HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 ENTERPRISE DR
DANVILLE KY
40422-1870
US

IV. Provider business mailing address

PO BOX 1213
DANVILLE KY
40423-1213
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-2425
  • Fax: 859-236-6152
Mailing address:
  • Phone: 859-236-2425
  • Fax: 859-236-6152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number400010
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number400010
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number400010
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code364SC2300X
TaxonomyChronic Care Clinical Nurse Specialist
License Number400010
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number400010
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code364SL0600X
TaxonomyLong-Term Care Clinical Nurse Specialist
License Number400010
License Number StateKY
# 7
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number400010
License Number StateKY

VIII. Authorized Official

Name: MS. JANELLE LANE WHEELER
Title or Position: EXECUTIVE DIRECTOR
Credential: L.C.S.W.
Phone: 859-236-2425