Provider Demographics
NPI:1033328232
Name:HOSPICE OF THE BLUEGRASS, INC
Entity Type:Organization
Organization Name:HOSPICE OF THE BLUEGRASS, INC
Other - Org Name:MOUNTAIN COMMUNITY HOSPICE, BLUEGRASS HOSPICE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE/CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CPA
Authorized Official - Phone:859-276-5344
Mailing Address - Street 1:1733 HARRODSBURG RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3617
Mailing Address - Country:US
Mailing Address - Phone:859-276-5344
Mailing Address - Fax:
Practice Address - Street 1:1733 HARRODSBURG RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3617
Practice Address - Country:US
Practice Address - Phone:859-276-5344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY400013207QH0002X, 207RH0002X, 251G00000X, 363LA2200X
KY363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community BasedGroup - Multi-Specialty
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY44097020Medicaid
KY44097020Medicaid