NPIMap

Organization Active NPI

Bluebird Hospice, LLC

  • Community Based Hospice Care Agency
  • Meridian, ID
National Provider Identifier
1104441963
Registry record updated May 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
BLUEBIRD HOSPICE, LLC
Practice address
3080 E Gentry Way Ste 203
Meridian, ID 83642-3544
Phone
(208) 336-9898
NPI assigned
Jun 8, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2025

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

Authorized official

Name
Amber L Tueller
Title
Secretary
Phone
(208) 207-2726

Specialties & licenses 1

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

Addresses

Primary practice location

3080 E Gentry Way Ste 203
Meridian, ID 83642-3544

Mailing address

3080 E Gentry Way Ste 203
Meridian, ID 83642-3544
Phone (208) 336-9898

Other names 1

  • Bluebird Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200710000589 ID Part A Provider - Hospice 6406279363 Practice locations: Meridian, ID

Hospice certification: CCN 131583

Legal name
BLUEBIRD HOSPICE LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Mar 9, 2021
Last certification
Mar 9, 2021
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Enrollment address
3080 E Gentry Way
Ste 203
Meridian, ID 83642-3013

Care Compare: Hospice

Medicare Care Compare
Listed as
Bluebird HospiceCCN 131583
Ownership
For-Profit
Certified
Mar 9, 2021
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
13D2196455Bluebird Hospice3080 Gentry Way Ste 203, Meridian, ID 83642Certificate of waiverOct 15, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Cornerstone Healthcare Inc Organization, Eagle, ID Corporation, For-profit 5% Or Greater Indirect Ownership Interest Jun 16, 2023 100%
Elevate HC Partners, LLC Organization, Eagle, ID LLC, For-profit 5% Or Greater Direct Ownership Interest Jun 1, 2020 100%
Brent Mills Individual Corporate OfficerTreasurer Mar 26, 2026
Brent Guerisoli Individual Corporate DirectorDirector Jun 16, 2023
The Pennant Group Inc Organization, Eagle, ID Corporation, For-profit 5% Or Greater Indirect Ownership Interest Jun 16, 2023
Ryan J Williams Individual W-2 Managing EmployeeMD; Sep 17, 2020
John J Gochnour Individual Corporate OfficerPresident / LLC Manager Apr 18, 2024
Justin Stenquist Individual W-2 Managing EmployeeAdministrator Jun 16, 2023
Amber Tueller Individual Corporate OfficerSecretary Apr 18, 2024
Elliot McMillan Individual Corporate OfficerVice President Apr 18, 2024

Owners & managing parties with NPI records 1

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

Facilities with the same owner 141

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

View all 141

Practitioners & affiliated clinicians

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": "1591574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748390400000",
    "number": "1104441963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3080 E GENTRY WAY STE 203",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836423544",
            "telephone_number": "208-336-9898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3080 E GENTRY WAY STE 203",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836423544",
            "telephone_number": "208-336-9898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEBIRD HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-08",
        "last_updated": "2025-05-28",
        "certification_date": "2025-05-28",
        "status": "A",
        "authorized_official_last_name": "TUELLER",
        "authorized_official_first_name": "AMBER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "208-207-2726"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bluebird Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bluebird Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.