Provider Demographics
NPI:1487626776
Name:PENNYROYAL HOSPICE, INC.
Entity Type:Organization
Organization Name:PENNYROYAL HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELONY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANDLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-885-6428
Mailing Address - Street 1:220 BURLEY AVE
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-8725
Mailing Address - Country:US
Mailing Address - Phone:270-885-6428
Mailing Address - Fax:855-270-7671
Practice Address - Street 1:220 BURLEY AVE
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-8725
Practice Address - Country:US
Practice Address - Phone:270-885-6428
Practice Address - Fax:855-270-7671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY400012251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY44024016Medicaid
KY44024016Medicaid