Provider Demographics
NPI:1043817000
Name:SIGNATURE HOSPICE EUGENE, LLC
Entity Type:Organization
Organization Name:SIGNATURE HOSPICE EUGENE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOFSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:971-224-2033
Mailing Address - Street 1:7632 SW DURHAM RD STE 105
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7597
Mailing Address - Country:US
Mailing Address - Phone:844-744-2200
Mailing Address - Fax:
Practice Address - Street 1:1200 EXECUTIVE PKWY STE 400
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2168
Practice Address - Country:US
Practice Address - Phone:541-689-3508
Practice Address - Fax:541-607-1739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based