Provider Demographics
NPI:1548744154
Name:HOMENURSE HOSPICE, LLC
Entity Type:Organization
Organization Name:HOMENURSE HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARBIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:770-229-9143
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:SUNNY SIDE
Mailing Address - State:GA
Mailing Address - Zip Code:30284-0637
Mailing Address - Country:US
Mailing Address - Phone:404-557-2371
Mailing Address - Fax:470-204-3060
Practice Address - Street 1:2920 N EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-6495
Practice Address - Country:US
Practice Address - Phone:770-229-9153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based