Provider Demographics
NPI:1194787366
Name:HOMESIDE HOSPICE, LLC
Entity type:Organization
Organization Name:HOMESIDE HOSPICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNABLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:732-381-3444
Mailing Address - Street 1:6 COMMERCE DR STE 206
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-3515
Mailing Address - Country:US
Mailing Address - Phone:732-381-3444
Mailing Address - Fax:732-381-3445
Practice Address - Street 1:6 COMMERCE DR STE 206
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-3515
Practice Address - Country:US
Practice Address - Phone:732-381-3444
Practice Address - Fax:732-381-3445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23391251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0086436Medicaid
NJ23391OtherDEPT OF HEALTH LICENSE #
NJ0086436Medicaid