Provider Demographics
NPI:1508390584
Name:HARBORSIDE HOSPICE OF MASSACHUSETTS, LLC
Entity Type:Organization
Organization Name:HARBORSIDE HOSPICE OF MASSACHUSETTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:800-331-1044
Mailing Address - Street 1:241 WINTER STREET, SUITE 201
Mailing Address - Street 2:P.O. BOX 930
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01831
Mailing Address - Country:US
Mailing Address - Phone:800-331-1044
Mailing Address - Fax:978-748-4384
Practice Address - Street 1:241 WINTER ST
Practice Address - Street 2:STE 201
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01831
Practice Address - Country:US
Practice Address - Phone:800-331-1044
Practice Address - Fax:978-748-4384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251G00000X251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based