Provider Demographics
NPI:1659374510
Name:HOSPICE OF THE BLUEGRASS, INC.
Entity Type:Organization
Organization Name:HOSPICE OF THE BLUEGRASS, INC.
Other - Org Name:BLUEGRASS HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:SHRIVER
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-296-6826
Mailing Address - Street 1:1733 HARRODSBURG ROAD
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:859-234-8750
Mailing Address - Fax:859-296-4101
Practice Address - Street 1:1317 US HIGHWAY 62E
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-7970
Practice Address - Country:US
Practice Address - Phone:859-276-5344
Practice Address - Fax:859-234-8671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150056251B00000X, 251E00000X, 252Y00000X
KY251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20091013Medicaid
KY15000557Medicaid
KY15001035Medicaid
KY20105011Medicaid
KY42001099Medicaid
KY45344579Medicaid
KY15001092Medicaid
KY20049011Medicaid
KY34002097Medicaid
KY42001099Medicaid