NPIMap

Organization Active NPI

Willamette Valley Hospice Inc

  • Community Based Hospice Care Agency
  • Salem, OR
National Provider Identifier
1093715070
Registry record updated Jan 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
N/A Issued in OR
Legal business name
WILLAMETTE VALLEY HOSPICE INC
Practice address
1015 3Rd St NW
Salem, OR 97304-4007
Phone
(503) 588-3600
Fax
(503) 363-3891
NPI assigned
Jul 29, 2005
Last updated
Jan 9, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2019

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

Authorized official

Name
Terry Lynn Dethrow
Title
Finance Manager
Phone
(503) 779-2308

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X N/A OR Primary

Addresses

Primary practice location

1015 3Rd St NW
Salem, OR 97304-4007

Mailing address

1015 3Rd St NW
Salem, OR 97304-4007
Phone (503) 588-3600

Other identifiers 3

IdentifierTypeStateIssuer
112347OtherORKAISER PERMANENTE
8008493OtherORREGENCE
132212MedicaidOR

Other names 1

  • Willamette Valley Hospice Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040621001881 OR Part A Provider - Hospice 2769467075 Practice locations: Salem, OR
O20170125002408 OR Part B Supplier - Clinic/Group Practice 2769467075 Receives reassigned benefits from 7 practitioners
Practice locations: Salem, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093715070. Details of each certification follow.

Hospice certification: CCN 381516

Legal name
WILLAMETTE VALLEY HOSPICE INC
Doing business as
WILLAMETTE VITAL HEALTH
Certification status
Active
Provider type (POS)
Hospice
Participating since
Aug 19, 2011
Last certification
Jul 28, 2012
Ownership / control type
Non-Profit - Other
Organization structure
CorporationNon-profit
Incorporated
Aug 10, 1978 in OR
Enrollment address
1015 3Rd St NW
Salem, OR 97304-4007

Care Compare: Hospice

Medicare Care Compare
Listed as
Willamette Vital HealthCCN 381516 · All quality measures
Ownership
Non-Profit
Certified
Aug 19, 2011
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
38D1087295Willamette Valley Hospice1015 3Rd St NW, Salem, OR 97304Certificate of waiverJul 30, 2026

National Provider Directory

National Provider Directory

Locations

1015 3rd St NW
Salem, OR 97304
Phone (503) 588-3600

Ownership & related parties

All disclosed owners & managing parties 22

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

NameRoleSinceShare
Wayne Kinkade Individual Corporate DirectorBoard Member Sep 23, 2023
Scott T Hadden Individual Corporate DirectorBoard Member Sep 23, 2023
Betty O'Brien Individual Corporate DirectorBoard Member Sep 1, 2009
Tara Friedman Individual Corporate OfficerChief Medical Officer May 23, 2025
Cheryl F Macdonald Individual W-2 Managing EmployeeMD; Sep 17, 2018
Chapters Health System Inc Organization, Temple Terrace, FL Operational/Managerial Control May 23, 2025
Andrew K Molosky Individual Corporate OfficerPresident May 23, 2025
John Moody Individual Corporate DirectorBoard Member Sep 23, 2023
Todd a Webb Individual Corporate OfficerChief Financial Officer May 23, 2025
Rhonda G White Individual Corporate OfficerPresident, Hospice and Pace May 23, 2025
Valerie Zolman Individual Corporate OfficerChief Compliance Officer May 23, 2025
Andrew Bone Individual Corporate DirectorBoard Member Sep 1, 2009
Carolyn Van Otten Individual Corporate DirectorBoard Member Sep 23, 2023
Mark Bidwell Individual Corporate DirectorBoard Member Sep 23, 2023
Jason M D'Auria Individual Corporate OfficerChief Operating Officer, Hospice May 23, 2025
Sheri Strobel Individual Corporate OfficerChief Information Officer May 23, 2025
Michael Cherry Individual Corporate DirectorBoard Member Sep 23, 2023
Vicki Holland Individual Corporate DirectorBoard Member Sep 23, 2023
Miriam Scharer Individual Corporate DirectorBoard Member Sep 23, 2023
Naomi Hormann Individual Corporate DirectorBoard Member Sep 23, 2023
Nicole Romence Individual Corporate OfficerChief People Officer May 23, 2025
Iria Nishimura Individual Corporate DirectorExecutive Director Sep 18, 2017
W-2 Managing EmployeeAd;Executive Director Sep 18, 2017 100%

Owners & managing parties with NPI records 2

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

Facilities with the same owner 9

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

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

Affiliated clinicians 1

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": "1122595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546992000000",
    "number": "1093715070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 3RD ST NW",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973044007",
            "telephone_number": "503-588-3600",
            "fax_number": "503-363-3891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 3RD ST NW",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973044007",
            "telephone_number": "503-588-3600",
            "fax_number": "503-363-3891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLAMETTE VALLEY HOSPICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-29",
        "last_updated": "2019-01-09",
        "status": "A",
        "authorized_official_last_name": "DETHROW",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "FINANCE MANAGER",
        "authorized_official_telephone_number": "503-779-2308"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "OR",
            "license": "N/A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER PERMANENTE",
            "identifier": "112347",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "8008493",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "132212",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willamette Valley Hospice",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Willamette Valley Hospice",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.