NPIMap

Organization Active NPI

Bethany Hospice, LLC

  • Community Based Hospice Care Agency
  • Everett, WA
National Provider Identifier
1760364095
Registry record updated Jul 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
BETHANY HOSPICE, LLC
Practice address
3202 Colby Ave Ste a
Everett, WA 98201-4324
Phone
(425) 526-5842
Fax
(425) 526-5842
NPI assigned
Jul 25, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2025

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

Authorized official

Name
Lori Healy
Title
Executive Director
Phone
(425) 344-2253

Specialties & licenses 1

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

Addresses

Primary practice location

3202 Colby Ave Ste a
Everett, WA 98201-4324

Mailing address

PO Box 13700
Mill Creek, WA 98082-1700
Phone (425) 526-7174

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251215002108 WA Part A Provider - Hospice 2567956725 Practice locations: Everett, WA

Hospice certification: CCN 501564

Legal name
BETHANY HOSPICE LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Feb 26, 2026
Last certification
Feb 5, 2026
Organization structure
LLC
Enrollment address
3202 Colby Ave
Ste a
Everett, WA 98201-4324

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
50D2332762Bethany Hospice LLC3202 Colby Ave, Everett, WA 98201Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Jeff F Gay Individual Corporate Director Apr 27, 2017 7.69%
Loren J Ihle Individual Corporate Director Jan 23, 2025 7.69%
Susan O Tiu Individual Corporate Director Jan 3, 2019 7.69%
Mahdiesadat Seyed Aliroteh Individual Corporate Director Apr 4, 2024 7.69%
Steven C Jacobson Individual Corporate Director Jun 27, 2018 7.72%
Bethany of the Northwest Organization, Mill Creek, WA Non-profit 5% Or Greater Direct Ownership Interest Feb 2, 2021 100%
Operational/Managerial Control Feb 2, 2021 100%
Veronica Knudson Individual Corporate Director Jan 23, 2025 7.69%
Lawrence B Stave Individual Corporate Director Jan 23, 2025 7.69%
Tristine C Bauguess Individual Operational/Managerial ControlDirector of Revenue Mar 22, 2017
Joseph R Scrivens Individual Corporate OfficerCeo Dec 6, 2019 100%
Robert C Dobler Individual Corporate Director Jan 23, 2025 7.69%
Lori a Healey Individual W-2 Managing EmployeeAd; Sep 30, 2024 100%
Janice E Nesse Individual Corporate Director Jan 23, 2025 7.69%
Terri K Wallin Individual Corporate Director Jul 23, 2020 7.69%
Spencer Glazier Individual W-2 Managing EmployeeMD; Feb 25, 2025
Patricia M Degroodt Individual Corporate Director Feb 1, 2023 7.69%
Eric D Nicholson Individual Corporate Director Oct 26, 2023 7.69%
David R Koenig Individual Corporate Director Mar 1, 2007 7.69%

Owners & managing parties with NPI records 6

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

Facilities with the same owner 4

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

NPI Registry JSON

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

{
    "created_epoch": "1753401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753401600000",
    "number": "1760364095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13700",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980821700",
            "telephone_number": "425-526-7174",
            "fax_number": "425-526-5842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3202 COLBY AVE STE A",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982014324",
            "telephone_number": "425-526-5842",
            "fax_number": "425-526-5842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHANY HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-25",
        "last_updated": "2025-07-25",
        "certification_date": "2025-07-25",
        "status": "A",
        "authorized_official_last_name": "HEALY",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "425-344-2253"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.