NPIMap

Organization Active NPI

Shalom Hospice of Southwest Washington LLC

  • Community Based Hospice Care Agency
  • Vancouver, WA
National Provider Identifier
1174414833
Registry record updated Jun 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
SHALOM HOSPICE OF SOUTHWEST WASHINGTON LLC
Practice address
3205 NE 78TH St Ste 10
Vancouver, WA 98665-0697
Phone
(360) 302-4600
Fax
(360) 326-1572
NPI assigned
Jul 11, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2026

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

Authorized official

Name
Samuel Stern
Title
Ceo
Phone
(510) 499-9977

Specialties & licenses 1

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

Addresses

Primary practice location

3205 NE 78TH St Ste 10
Vancouver, WA 98665-0697

Mailing address

3205 NE 78TH St Ste 10
Vancouver, WA 98665-0697
Phone (360) 302-4600

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251212000511 WA Part A Provider - Hospice 9830683283 Practice locations: Vancouver, WA

Hospice certification: CCN 501565

Legal name
SHALOM HOSPICE OF SOUTHWEST WASHINGTON LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Mar 5, 2026
Last certification
Mar 5, 2026
Organization structure
LLCProprietary
Enrollment address
3205 NE 78TH St
Ste 10
Vancouver, WA 98665-0697

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
50D2339878Shalom Hospice of Southwest Washington LLC3205 NE 78TH St Ste 10, Vancouver, WA 98665Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Sygs Management LLC Organization, Brooklyn, NY LLC, Holding company 5% Or Greater Direct Ownership Interest Oct 10, 2024 100%
Don Nguyen Individual W-2 Managing EmployeeMD; Oct 10, 2024
Samuel Stern Individual Contracted Managing EmployeeCeo Oct 10, 2024
5% Or Greater Indirect Ownership Interest Oct 10, 2024 5%
Corporate OfficerMember Oct 10, 2024
Corporate Director Oct 10, 2024
W-2 Managing EmployeeCeo Oct 10, 2024
Sygs 2023 Trust Organization, Brooklyn, NY LLC 5% Or Greater Indirect Ownership Interest Oct 10, 2024 95%
Patrick Shepard Individual W-2 Managing EmployeeAd; Oct 10, 2024

Owners & managing parties with NPI records 1

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

  • Don Nguyen
    • Geriatric Medicine (Internal Medicine) Physician
    • Houston, TX
    • NPI 1720344617

    W-2 Managing Employee

    CMS ownership

Facilities with the same owner 9

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

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": "1752192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780963200000",
    "number": "1174414833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3205 NE 78TH ST STE 10",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986650697",
            "telephone_number": "360-302-4600",
            "fax_number": "360-326-1572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3205 NE 78TH ST STE 10",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986650697",
            "telephone_number": "360-302-4600",
            "fax_number": "360-326-1572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHALOM HOSPICE OF SOUTHWEST WASHINGTON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-11",
        "last_updated": "2026-06-09",
        "certification_date": "2026-06-09",
        "status": "A",
        "authorized_official_last_name": "STERN",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "510-499-9977"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.