Provider Demographics
NPI:1497758189
Name:TRADITIONS HOSPICE OF HIGHLAND HEIGHTS, LLC
Entity type:Organization
Organization Name:TRADITIONS HOSPICE OF HIGHLAND HEIGHTS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO & SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KERNDL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-704-6574
Mailing Address - Street 1:6840 CAROTHERS PKWY STE 550
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8002
Mailing Address - Country:US
Mailing Address - Phone:979-704-6547
Mailing Address - Fax:866-908-8704
Practice Address - Street 1:677H ALPHA DRIVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2165
Practice Address - Country:US
Practice Address - Phone:440-386-2500
Practice Address - Fax:440-449-1142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0112 HSP251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0112 HSPOtherSTATE LICENSE
OH2031027Medicaid
OH361602Medicare Oscar/Certification