Provider Demographics
NPI:1033530035
Name:NORTHWEST HOSPICE, LLC
Entity Type:Organization
Organization Name:NORTHWEST HOSPICE, LLC
Other - Org Name:SIGNATURE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MSPT
Authorized Official - Phone:503-783-2473
Mailing Address - Street 1:25117 SW PARKWAY AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9697
Mailing Address - Country:US
Mailing Address - Phone:971-224-2505
Mailing Address - Fax:503-682-2132
Practice Address - Street 1:1000 S 16TH ST STE C
Practice Address - Street 2:
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-3403
Practice Address - Country:US
Practice Address - Phone:208-642-9222
Practice Address - Fax:208-642-9224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20004431OtherMEDICARE PART B
ID131510Medicare Oscar/Certification