Provider Demographics
NPI:1114065018
Name:HOSPICE HOME CARE, LLC
Entity Type:Organization
Organization Name:HOSPICE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION SVP OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:KENSLOW
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:501-558-4100
Mailing Address - Street 1:2200 S BOWMAN RD STE A
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4136
Mailing Address - Country:US
Mailing Address - Phone:501-558-4100
Mailing Address - Fax:501-221-0687
Practice Address - Street 1:990 HIGHWAY 425 N
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-4441
Practice Address - Country:US
Practice Address - Phone:870-367-9008
Practice Address - Fax:501-221-0687
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPICE HOME CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-02
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3712251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR137628747Medicaid
AR041523Medicare ID - Type UnspecifiedHOSPICE
AR041523Medicare Oscar/Certification