NPIMap

Organization Active NPI

Life Source Services LLC

  • Community Based Hospice Care Agency
  • Oradell, NJ
National Provider Identifier
1396707139
Registry record updated Jul 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
22933 Issued in NJ
Legal business name
LIFE SOURCE SERVICES LLC
Practice address
700 Kinderkamack Rd Ste 105
Oradell, NJ 07649
Phone
(888) 865-5103
Fax
(201) 225-4769
NPI assigned
Apr 5, 2006
Last updated
Jul 20, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Irina Etinger
Title
Cpa
Phone
(303) 231-1412

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 22933 NJ Primary

Addresses

Primary practice location

700 Kinderkamack Rd Ste 105
Oradell, NJ 07649

Mailing address

245 S Benton St
Lakewood, CO 80226-2453
Phone (303) 231-1203

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050617000751 NJ Part A Provider - Hospice 9739123902 Practice locations: Oradell, NJ
O20171018000281 NJ Part B Supplier - Clinic/Group Practice 9739123902 Receives reassigned benefits from 2 practitioners
Practice locations: Oradell, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396707139. Details of each certification follow.

Hospice certification: CCN 311549

Legal name
LIFE SOURCE SERVICES LLC
Doing business as
JOURNEY PALLIATIVE CARE & TRANSITIONS
Certification status
Active
Provider type (POS)
Hospice
Participating since
May 30, 2001
Last certification
Feb 8, 2019
Ownership / control type
Proprietary - Partnership
Organization structure
LLCProprietary
Incorporated
Nov 8, 2000 in NJ
Enrollment address
700 Kinderkamack Rd
Ste 105
Oradell, NJ 07649-1533

Care Compare: Hospice

Medicare Care Compare
Listed as
Life Source Services LLCCCN 311549 · All quality measures
Ownership
For-Profit
Certified
May 30, 2001
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D2328800Life Source Services LLC700 Kinderkamack Road, Oradell, NJ 07649Certificate of waiverAug 17, 2027

National Provider Directory

National Provider Directory
Tax ID family
Journey Palliative Care and Transitions2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

700 Kinderkamack Rd
Ste 105
Oradell, NJ 07649
Phone (201) 523-9749

230 E Ridgewood Ave
#307
Paramus, NJ 07652
Phone (201) 967-7625

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Timothy Brabston Individual W-2 Managing EmployeeMD; Apr 1, 2024
Jumana Chalabi Individual W-2 Managing EmployeeMD; Apr 1, 2024
Hinde Wein Individual OtherTrustee Nov 8, 2000
Stefanos G Pantagis Individual W-2 Managing EmployeeMD; Apr 1, 2023
Dayna a Prenenski Individual W-2 Managing EmployeeAd; Jan 1, 2024 100%
Joseph Sebbag Individual Other Nov 20, 2012
Odessa E Hoinkis Individual W-2 Managing EmployeeMD; Jun 1, 2024
Irina Etinger Individual Corporate OfficerCfo May 7, 2014
Universal General Trust Organization, Denver, CO 5% Or Greater Direct Ownership Interest Nov 8, 2000 33%
Premier Advisors LLC Organization, Lakewood, CO LLC 5% Or Greater Direct Ownership Interest Nov 8, 2000 66%
Joel S Adler Individual W-2 Managing EmployeeMD; Apr 1, 2024
Michael Francone Individual Other Nov 8, 2000
Solomon Melamed Individual OtherManaging Member Nov 8, 2000 1%
Alicia Skarimbas Individual W-2 Managing EmployeeMD; Jan 1, 2024

Owners & managing parties with NPI records 6

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 6

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532044800000",
    "number": "1396707139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 S BENTON ST",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802262453",
            "telephone_number": "303-231-1203",
            "fax_number": "303-234-0124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 KINDERKAMACK RD STE 105",
            "city": "ORADELL",
            "state": "NJ",
            "postal_code": "07649",
            "telephone_number": "888-865-5103",
            "fax_number": "201-225-4769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE SOURCE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-05",
        "last_updated": "2018-07-20",
        "status": "A",
        "authorized_official_last_name": "ETINGER",
        "authorized_official_first_name": "IRINA",
        "authorized_official_title_or_position": "CPA",
        "authorized_official_telephone_number": "303-231-1412",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NJ",
            "license": "22933",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oradell, NJ

Sources for this page

Verify at the official NPI Registry.