Healthcare Provider Details

I. General information

NPI: 1487626776
Provider Name (Legal Business Name): PENNYROYAL HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 BURLEY AVE
HOPKINSVILLE KY
42240-8725
US

IV. Provider business mailing address

220 BURLEY AVE
HOPKINSVILLE KY
42240-8725
US

V. Phone/Fax

Practice location:
  • Phone: 270-885-6428
  • Fax: 855-270-7671
Mailing address:
  • Phone: 270-885-6428
  • Fax: 855-270-7671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number400012
License Number StateKY

VIII. Authorized Official

Name: MRS. MELONY L SANDLIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 270-885-6428