Provider Demographics
NPI:1790784312
Name:HOSPICE OF SOUTHERN KENTUCKY
Entity Type:Organization
Organization Name:HOSPICE OF SOUTHERN KENTUCKY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:270-782-3402
Mailing Address - Street 1:5872 SCOTTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-7853
Mailing Address - Country:US
Mailing Address - Phone:270-782-3402
Mailing Address - Fax:270-782-0588
Practice Address - Street 1:5872 SCOTTSVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-7853
Practice Address - Country:US
Practice Address - Phone:270-782-3402
Practice Address - Fax:270-782-0588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207QH0002X
KY400006251G00000X
KY251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community Based
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY44114015Medicaid
KY44114015Medicaid