Walla Walla Community Hospice

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

IS-469 Issued in WA

Legal business name

WALLA WALLA COMMUNITY HOSPICE

Practice address

1067 E Isaacs Ave
Walla Walla, WA 99362-2040

Phone

(509) 525-5561

Fax

(509) 525-3517

NPI assigned

Jun 9, 2005

Organization subpart

No

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

Authorized official

Name

Rebecca L Hendricks

Title

Executive Director

Phone

(509) 525-5561

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WA2 enrollments

Enrollment records 2

Hospice certification: CCN 501520

Legal name

WALLA WALLA COMMUNITY HOSPICE

Certification status

Active

Provider type (POS)

Hospice

Participating since

Jul 26, 1988

Last certification

Jul 1, 2021

Ownership / control type

Non-Profit - Other

Organization structure

CorporationNon-profit

Incorporated

Oct 13, 1980 in WA

Enrollment address

1067E Isaacs Ave
Walla Walla, WA 99362-2040

Listed as

Walla Walla Community HospiceCCN 501520 · All quality measures

Ownership

Non-Profit

Certified

Jul 26, 1988

Medicare certification status

ActiveFrom the Provider of Services file

Locations

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.

Owners & managing parties with NPI records 1

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

• Julian Thomas Pierce, M.D.

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Tarpon Springs, FL
  • NPI 1700035268

  Contracted Managing Employee

  CMS ownership

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Dustin Colegrove, D.O.

  • Internal Medicine Physician
  • Vancouver, WA
  • NPI 1467686147
  Medicare reassignment NPD
• Christopher K Jenkins, DO

  • Emergency Medicine Physician
  • Walla Walla, WA
  • NPI 1962495994

  Family Medicine

  Medicare reassignment NPD
• Shelly M McDiarmid, PT

  • Physical Therapist
  • Walla Walla, WA
  • NPI 1730205204
  NPD
• Jenna Rae Watts, RN

  • Hospice Registered Nurse
  • Walla Walla, WA
  • NPI 1992597793
  NPD
• Vicki Jackson

  • Mental Health Counselor
  • Homer, AK
  • NPI 1083076772
  NPD

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497759203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2026",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993620948",
            "telephone_number": "509-525-5561",
            "fax_number": "509-525-3517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1067 E ISAACS AVE",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993622040",
            "telephone_number": "509-525-5561",
            "fax_number": "509-525-3517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLA WALLA COMMUNITY HOSPICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HENDRICKS",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "509-525-5561"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "WA",
            "license": "IS-469",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "132121",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3990132",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walla Walla Alliance for the Homeless
• Walla Walla Cardiology Specialist Clinic,P.S.
• Walla Walla Chiropractic
• Walla Walla Chiropractic and Associates PLLC
• Walla Walla Clinic, Inc. (Walla Walla Clinic Ambulatory Surgery Center)
• Walla Walla County Fire District 4
• Walla Walla General Hospital (Adventist Health Community Pharmacy)
• Walla Walla General Hospital
• Walla Walla General Hospital
• Walla Walla General Hospital

• Community Based Hospice Care Agency in Walla Walla, WA
• Providers in Walla Walla, WA by specialty
• Community Based Hospice Care Agency in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.