Provider Demographics
NPI:1477010940
Name:ENVISION HOSPICE OF WASHINGTON LLC
Entity Type:Organization
Organization Name:ENVISION HOSPICE OF WASHINGTON LLC
Other - Org Name:ENVISION HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SHERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-225-7971
Mailing Address - Street 1:181 S 333RD ST STE C120
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7363
Mailing Address - Country:US
Mailing Address - Phone:360-350-4875
Mailing Address - Fax:
Practice Address - Street 1:181 S 333RD ST STE C120
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7363
Practice Address - Country:US
Practice Address - Phone:360-350-4875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-21
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA39033384Medicaid