NPIMap

Organization Active NPI

King County Public Hospital District No. 2

Doing business as EvergreenHealth Hospice Care

  • Community Based Hospice Care Agency
  • Kirkland, WA
National Provider Identifier
1285719609
Registry record updated Nov 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
KING COUNTY PUBLIC HOSPITAL DISTRICT NO. 2
Doing business as
EvergreenHealth Hospice Care
Practice address
12822 124TH LN NE
Kirkland, WA 98034-7612
Phone
(425) 899-3300
NPI assigned
Oct 25, 2006
Last updated
Nov 6, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
KING COUNTY PUBLIC HOSPITAL DISTRICT NO. 2As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 6, 2024

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

Authorized official

Name
William Howe
Title
Cfo
Phone
(425) 899-2606

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X NU Primary
Inpatient Hospice 315D00000X NU

Addresses

Primary practice location

12822 124TH LN NE
Kirkland, WA 98034-7612

Mailing address

12040 NE 128TH St
Ms #103
Kirkland, WA 98034-3013
Phone (425) 899-3300

Other identifiers 1

IdentifierTypeStateIssuer
3990231MedicaidWA

Other names 1

  • EvergreenHealth Hospice Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050318000074 WA Part A Provider - Hospice 7618880097 Practice locations: Kirkland, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285719609. Details of each certification follow.

Hospice certification: CCN 501523

Legal name
KING COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Doing business as
EVERGREENHEALTH HOSPICE CARE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 27, 1990
Last certification
Jun 17, 2021
Ownership / control type
Combination Government and Nonprofit
Organization structure
OtherNon-profit
Incorporated
Mar 9, 1972 in WA
Enrollment address
11800 NE 128TH St #200
Kirkland, WA 98034-7211

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Evergreen Health Hospice CareCCN 501523 · All quality measures
Ownership
Combination Government & Non-Profit
Certified
Jun 27, 1990
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Public Hosp District No 225 organizations share this tax ID, including this one
Part of
Public Hosp District No 2

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

Locations

12040 NE 128th St
#103
Kirkland, WA 98034
Phone (425) 899-3300

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Monique Bushore Gablehouse Individual Corporate OfficerCoo Post Acute Care Jan 1, 2024 100%
Operational/Managerial ControlCoo Post Acute Care Jan 1, 2024 100%
Cheryl Madawattage Individual Corporate DirectorExecutive Director Hospice Jan 1, 2024 100%
Operational/Managerial ControlExecutive Director Hospice Jan 1, 2024 100%
William Howe Individual Corporate OfficerChief Financial Officer Jul 22, 2024
Operational/Managerial ControlChief Financial Officer Jul 22, 2024
Hope a Wechkin Individual Corporate DirectorHospice Medical Director Jan 1, 2024 100%
Operational/Managerial ControlHospice Medical Director Jan 1, 2024 100%
King County Public Hospital District No 2 Organization, Kirkland, WA 5% Or Greater Direct Ownership Interest Mar 9, 1972 100%
Ettore G Palazzo Individual Corporate OfficerCeo Dec 10, 2023
Operational/Managerial ControlCeo Dec 10, 2023

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Evergreenhealth Medical CenterKirkland, WA, CCN 500124 Hospital 5% Or Greater Direct Ownership Interest (100%) Mar 9, 1972
Evergreenhealth Medical CenterKirkland, WA, CCN 50T124 Hospital 5% Or Greater Direct Ownership Interest (100%) Mar 9, 1972
Evergreen Health MonroeMonroe, WA, CCN 500084 Hospital Operational/Managerial Control (100%) Mar 1, 2015
Evergreenhealth Home CareKirkland, WA, CCN 507079 Home health agency Operational/Managerial Control (100%) Jan 2, 1968

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 25

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 25

Affiliated clinicians 53

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 53

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730851200000",
    "number": "1285719609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12040 NE 128TH ST",
            "address_2": "MS #103",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980343013",
            "telephone_number": "425-899-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12822 124TH LN NE",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980347612",
            "telephone_number": "425-899-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KING COUNTY PUBLIC HOSPITAL DISTRICT NO. 2",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KING COUNTY PUBLIC HOSPITAL DISTRICT NO. 2",
        "enumeration_date": "2006-10-25",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A",
        "authorized_official_last_name": "HOWE",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "425-899-2606"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "315D00000X",
            "taxonomy_group": "",
            "desc": "Hospice, Inpatient",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3990231",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EvergreenHealth Hospice Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "EvergreenHealth Hospice Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kirkland, WA

Sources for this page

Verify at the official NPI Registry.