Provider Demographics
NPI:1194744664
Name:ADVENTHEALTH HOME HEALTH AND HOSPICE INC
Entity type:Organization
Organization Name:ADVENTHEALTH HOME HEALTH AND HOSPICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-545-1409
Mailing Address - Street 1:210 MARIE LANGDON DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-6388
Mailing Address - Country:US
Mailing Address - Phone:606-598-1969
Mailing Address - Fax:606-598-2062
Practice Address - Street 1:509 MEMORIAL DR STE 2
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-6196
Practice Address - Country:US
Practice Address - Phone:606-598-1969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150039251E00000X
251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000054585OtherBLUE CROSS BLUE SHIELD KY
KY0005154214OtherAETNA
WV001703971OtherBLUE CROSS BLUE SHIELD WV
KY100443100OtherPASSPOST HEALTH PLAN
KY610594620OtherTRICARE
KY610594620OtherMISC INSURANCE
KY65265OtherMEMORIAL EMPLOYEES
OHA87696OtherMEDICAID OHIO
KY100443100OtherMEDICAID PENDING
KY65265OtherANTHEM BLUE CROSS
IN100033950AOtherINDIANA MEDICAID
KY180043OtherMEDICARE MANAGED CARE
KY34002808Medicaid
KY610594620OtherCHAMPVA
TN1004431OtherMEDICAID TENNESSEE
WV1038912OtherBRICK STREET MTL WV WC
KY4200280Medicaid
KY5000038OtherUNITED HEALTHCARE
KY30523000OtherBLACK LUNG
KY180043OtherMEDICARE MANAGED CARE