NPIMap

Organization Active NPI

Envision Hospice of Washington LLC

Doing business as Envision Hospice

  • Community Based Hospice Care Agency
  • Federal Way, WA
National Provider Identifier
1477010940
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
ENVISION HOSPICE OF WASHINGTON LLC
Doing business as
Envision Hospice
Practice address
181 S 333Rd St Ste C120
Federal Way, WA 98003-7363
Phone
(360) 350-4875
NPI assigned
Feb 21, 2019
Last updated
Jul 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Authorized official

Name
Jennifer Petersen
Title
Corporate Director of Compliance
Phone
(801) 885-8275

Specialties & licenses 1

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

Addresses

Primary practice location

181 S 333Rd St Ste C120
Federal Way, WA 98003-7363

Mailing address

181 S 333Rd St Ste C120
Federal Way, WA 98003-7363
Phone (360) 350-4875

Other identifiers 1

IdentifierTypeStateIssuer
39033384MedicaidWA

Other names 1

  • Envision Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190717000028 WA Part A Provider - Hospice 5597090399 Practice locations: Tacoma, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477010940. Details of each certification follow.

Hospice certification: CCN 501544

Legal name
ENVISION HOSPICE OF WASHINGTON LLC
Doing business as
ENVISION HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Feb 19, 2020
Last certification
Feb 19, 2020
Ownership / control type
Proprietary - Other
Organization structure
LLCProprietary
Incorporated
Feb 19, 2019 in WA
Enrollment address
1818 S Union Ave
Ste 1a
Tacoma, WA 98405-1953

Care Compare: Hospice

Medicare Care Compare
Listed as
Envision HospiceCCN 501544 · All quality measures
Ownership
For-Profit
Certified
Feb 19, 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
50D2312344Envision Hospice1818 S Union Ave Ste 1a, Tacoma, WA 98405Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Locations

181 S 333rd St
Ste 120
Federal Way, WA 98003
Phone (206) 347-8250

181 S 333rd St
Ste C120
Federal Way, WA 98003
Phone (360) 350-4875

402 Black Hills Ln SW
Ste 402B
Olympia, WA 98502
Phone (360) 350-4875

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
PNC Holding LLC Organization, Pittsburgh, PA LLC 5% Or Greater Indirect Ownership Interest Apr 30, 2021 7.86%
Fifth Third Bank Organization, Cincinnati, OH Corporation, Financial institution, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 30, 2021 6.55%
PNC Capital Finance LLC Organization, Pittsburgh, PA Financial institution 5% Or Greater Indirect Ownership Interest Apr 30, 2021 7.86%
Yvonne Hines Individual W-2 Managing EmployeeAd; Oct 1, 2024
State Automobile Mutual Insurance Company Organization, Columbus, OH Corporation, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 30, 2021 6.55%
Kevin Henning Individual Contracted Managing EmployeeMD; Jan 21, 2025
Liberty Mutual Holding Company, Inc. Organization, Boston, MA Corporation 5% Or Greater Indirect Ownership Interest Apr 30, 2021 6.55%
Jason Harms Individual Corporate OfficerCeo, Cfo Apr 23, 2023
W-2 Managing EmployeeCeo, Cfo Apr 3, 2023
Envision Wa HHA, LLC Organization, Chicago, IL Created for acquisition, LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 30, 2021 100%
Envision Holdco LLC Organization, Chicago, IL Created for acquisition, LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 30, 2021 100%
Dispatch Printing Co Organization, Columbus, OH Corporation, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 30, 2021 6.55%
Fifth Third Capital Holdings, LLC Organization, Cincinnati, OH LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 30, 2021 6.55%
Jessica Yoos Individual Contracted Managing EmployeeMD; Mar 5, 2024
PNC Capital Finance, LLC Organization, Pittsburgh, PA LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 30, 2021 7.86%
The Huntington National Bank Organization, Columbus, OH Corporation, Financial institution, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 30, 2021 9.84%
Envision Home Health of Washington LLC Organization, Tacoma, WA LLC, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Apr 30, 2021 100%
Stonehenge Opportunity Fund IV LP Organization, Columbus, OH For-profit, Private equity company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 30, 2021 92.3%

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 11

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

Practitioners & affiliated clinicians

Practitioners 1

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.

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": "1550707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721001600000",
    "number": "1477010940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "181 S 333RD ST STE C120",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980037363",
            "telephone_number": "360-350-4875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "181 S 333RD ST STE C120",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980037363",
            "telephone_number": "360-350-4875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENVISION HOSPICE OF WASHINGTON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-21",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CORPORATE DIRECTOR OF COMPLIANCE",
        "authorized_official_telephone_number": "801-885-8275"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39033384",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Envision Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Envision Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Federal Way, WA

Sources for this page

Verify at the official NPI Registry.