MEDICARE: ADVENTHEALTH HOME HEALTH AND 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
1	251X00000X	Supports Brokerage Agency
2	251E00000X	Home Health Agency	150039	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
12	180043	OTHER	KY	MEDICARE MANAGED CARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000054585	OTHER	KY	BLUE CROSS BLUE SHIELD KY
2	0005154214	OTHER	KY	AETNA
3	001703971	OTHER	WV	BLUE CROSS BLUE SHIELD WV
4	100443100	OTHER	KY	PASSPOST HEALTH PLAN
5	610594620	OTHER	KY	TRICARE
6	610594620	OTHER	KY	MISC INSURANCE
7	65265	OTHER	KY	MEMORIAL EMPLOYEES
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	65265	OTHER	KY	ANTHEM BLUE CROSS
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	610594620	OTHER	KY	CHAMPVA
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
16	1038912	OTHER	WV	BRICK STREET MTL WV WC
17	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
18	5000038	OTHER	KY	UNITED HEALTHCARE
19	30523000	OTHER	KY	BLACK LUNG

General Provider Information

NPI Number	:	1194744664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVENTHEALTH HOME HEALTH AND HOSPICE INC

Provider Business Mailing Address
First Line	:	210 MARIE LANGDON DR
Second Line	:
City	:	MANCHESTER
State	:	KY
Zip	:	40962-6388
Country	:	US
Telephone Number	:	606-598-1969
Fax Number	:	606-598-2062

Provider Business Practice Location Address
First Line	:	509 MEMORIAL DR STE 2
Second Line	:
City	:	MANCHESTER
State	:	KY
Zip	:	40962-6196
Country	:	US
Telephone Number	:	606-598-1969
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MARK WHEELER
Credential	:
Telephone Number	:	530-545-1409

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	01/02/2025

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