NPIMap

Organization Active NPI

Harborside Hospice, LLC

  • Community Based Hospice Care Agency
  • Plaistow, NH
National Provider Identifier
1679021638
Registry record updated Sep 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
HARBORSIDE HOSPICE, LLC
Practice address
23 Atkinson Depot Rd Ste 105
Plaistow, NH 03865-3141
Phone
(800) 331-1044
Fax
(603) 546-7766
NPI assigned
Sep 19, 2016
Last updated
Sep 19, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2016

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

Authorized official

Name
Timothy Barry
Title
Executive Director
Phone
(800) 331-1044

Specialties & licenses 1

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

Addresses

Primary practice location

23 Atkinson Depot Rd Ste 105
Plaistow, NH 03865-3141

Mailing address

23 Atkinson Depot Rd Ste 105
Plaistow, NH 03865-3141
Phone (800) 331-1044

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170630000233 NH Part A Provider - Hospice 2769751007 Practice locations: Plaistow, NH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679021638. Details of each certification follow.

Hospice certification: CCN 301534

Legal name
HARBORSIDE HOSPICE LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Oct 12, 2017
Last certification
Mar 12, 2021
Ownership / control type
Proprietary - Other
Organization structure
LLCProprietary
Incorporated
Jul 5, 2016 in NH
Enrollment address
23 Atkinson Depot Rd
Ste 105
Plaistow, NH 03865-3141

Care Compare: Hospice

Medicare Care Compare
Listed as
Harborside Hospice LLCCCN 301534 · All quality measures
Ownership
Other
Certified
Oct 12, 2017
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
30D2117682Harborside Hospice, LLC23 Atkinson Depot Rd, Ste 105, Plaistow, NH 03865Certificate of waiverAug 21, 2026

National Provider Directory

National Provider Directory

Locations

23 Atkinson Depot Rd
Ste 105
Plaistow, NH 03865
Phone (800) 331-1044

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Timothy G Barry Individual 5% Or Greater Direct Ownership Interest Jul 5, 2016 90%
Corporate DirectorAdministrator Jul 5, 2016 90%
Sylvie J Hornor Individual 5% Or Greater Direct Ownership Interest Jul 5, 2016 10%
Operational/Managerial ControlClinical Service Director Jul 5, 2016 10%

Practitioners & affiliated clinicians

Affiliated clinicians 8

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": "1474243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474243200000",
    "number": "1679021638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 ATKINSON DEPOT RD STE 105",
            "city": "PLAISTOW",
            "state": "NH",
            "postal_code": "038653141",
            "telephone_number": "800-331-1044",
            "fax_number": "603-546-7766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 ATKINSON DEPOT RD STE 105",
            "city": "PLAISTOW",
            "state": "NH",
            "postal_code": "038653141",
            "telephone_number": "800-331-1044",
            "fax_number": "603-546-7766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARBORSIDE HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-19",
        "last_updated": "2016-09-19",
        "status": "A",
        "authorized_official_last_name": "BARRY",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "800-331-1044"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plaistow, NH

Sources for this page

Verify at the official NPI Registry.