Provider Demographics
NPI:1255497574
Name:OHIO COUNTY HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:OHIO COUNTY HOSPITAL CORPORATION
Other - Org Name:HOSPICE OF OHIO COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PFS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-504-1910
Mailing Address - Street 1:107 GILLESPIE ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347-1607
Mailing Address - Country:US
Mailing Address - Phone:270-298-9507
Mailing Address - Fax:270-298-3824
Practice Address - Street 1:1211 OLD MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347-1619
Practice Address - Country:US
Practice Address - Phone:270-298-5281
Practice Address - Fax:270-298-3806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY400032251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY400032OtherKY LICENSE
KY44092013Medicaid
KY400032OtherKY LICENSE
KY400032OtherKY LICENSE