Healthcare Provider Details

I. General information

NPI: 1851494124
Provider Name (Legal Business Name): HOSPICE OF LAKE CUMBERLAND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PARKWAY DR
SOMERSET KY
42503-3450
US

IV. Provider business mailing address

100 PARKWAY DRIVE
SOMERSET KY
42503
US

V. Phone/Fax

Practice location:
  • Phone: 606-679-4389
  • Fax: 606-679-2971
Mailing address:
  • Phone: 606-679-4389
  • Fax: 606-679-2971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. BRIAN J DAVIS
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 606-679-4389