Provider Demographics
NPI:1922325513
Name:HOSPICE OF THE BLUEGRASS, INC
Entity Type:Organization
Organization Name:HOSPICE OF THE BLUEGRASS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE, CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:SHRIVER
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-276-5344
Mailing Address - Street 1:1733 HARRODSBURG RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3667
Mailing Address - Country:US
Mailing Address - Phone:859-276-5344
Mailing Address - Fax:859-296-4101
Practice Address - Street 1:1733 HARRODSBURG RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3667
Practice Address - Country:US
Practice Address - Phone:859-276-5344
Practice Address - Fax:859-296-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41461207QH0002X
KY251J00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65928418Medicaid
KY7100298800Medicaid
KY1013054626OtherNPI