NPIMap

Organization Active NPI

Glacier Peak Healthcare, Inc.

Doing business as Alpha Hospice

  • Community Based Hospice Care Agency
  • Everett, WA
National Provider Identifier
1346886561
Registry record updated Mar 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
GLACIER PEAK HEALTHCARE, INC.
Doing business as
Alpha Hospice
Practice address
10530 19TH Ave SE Ste 201
Everett, WA 98208-4282
Phone
(425) 595-3059
NPI assigned
Nov 22, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2021

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

Authorized official

Name
Lee Johnson
Title
Treasurer
Phone
(208) 401-1369

Specialties & licenses 1

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

Addresses

Primary practice location

10530 19TH Ave SE Ste 201
Everett, WA 98208-4282

Mailing address

10530 19TH Ave SE Ste 201
Everett, WA 98208-4282
Phone (425) 595-3059

Other names 1

  • Alpha Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191223001530 WA Part A Provider - Hospice 8820363369 Practice locations: Everett, WA

Hospice certification: CCN 501546

Legal name
GLACIER PEAK HEALTHCARE INC
Doing business as
ALPHA HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Sep 11, 2020
Last certification
Sep 11, 2020
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Aug 3, 2017 in NV
Enrollment address
10530 19TH Ave SE
Ste 201
Everett, WA 98208-4282

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Alpha HospiceCCN 501546 · All quality measures
Ownership
For-Profit
Certified
Sep 11, 2020
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
50D2220214Alpha Hospice10530 19TH Ave SE Ste 201, Everett, WA 98208Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Alpha Home Health3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

10530 19th Ave SE
Ste 201
Everett, WA 98208
Phone (425) 357-1790

Ownership & related parties

All disclosed owners & managing parties 8

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 Direct Ownership Interest Dec 1, 2019 100%
Stanley S.L. Ling Individual Contracted Managing EmployeeMD; Jan 2, 2023
Brent Mills Individual Corporate OfficerTreasurer Mar 25, 2026
Gurpreet Dhillon Individual W-2 Managing EmployeeAd; Mar 3, 2026
Brent Guerisoli Individual Corporate DirectorDirector and Sole Board Member Aug 4, 2022
The Pennant Group Inc Organization, Eagle, ID Corporation, For-profit 5% Or Greater Indirect Ownership Interest Dec 1, 2019 100%
John J Gochnour Individual Corporate OfficerPresident/LLC Manager Jul 31, 2025
Amber Tueller Individual Corporate OfficerSecretary Jul 31, 2025

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 2

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": "1574380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615766400000",
    "number": "1346886561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10530 19TH AVE SE STE 201",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982084282",
            "telephone_number": "425-595-3059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10530 19TH AVE SE STE 201",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982084282",
            "telephone_number": "425-595-3059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLACIER PEAK HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-22",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "208-401-1369"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alpha Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Alpha Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.