NPIMap

Organization Active NPI

Shalom Hospice of Puget Sound LLC

  • Community Based Hospice Care Agency
  • Poulsbo, WA
National Provider Identifier
1871312934
Registry record updated Jun 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
SHALOM HOSPICE OF PUGET SOUND LLC
Practice address
19352 Viking Ave NW Ste C
Poulsbo, WA 98370-7276
Phone
(510) 499-9977
NPI assigned
Oct 7, 2024
Last updated
Jun 9, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2026

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

Authorized official

Name
Samuel Stern
Title
Ceo
Phone
(510) 499-9977

Specialties & licenses 1

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

Addresses

Primary practice location

19352 Viking Ave NW Ste C
Poulsbo, WA 98370-7276

Mailing address

19352 Viking Ave NW Ste a
Poulsbo, WA 98370-7276
Phone (360) 994-1200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250421001396 WA Part A Provider - Hospice 1052836228 Practice locations: Poulsbo, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871312934. Details of each certification follow.

Hospice certification: CCN 501561

Legal name
SHALOM HOSPICE OF PUGET SOUND LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
May 23, 2025
Last certification
May 23, 2025
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Enrollment address
19352 Viking Ave NW
Ste a
Poulsbo, WA 98370-7276

Care Compare: Hospice

Medicare Care Compare
Listed as
Shalom Hospice of Puget Sound LLCCCN 501561 · All quality measures
Certified
May 23, 2025
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
50D2319316Shalom Hospice of Puget Sound LLC19352 Viking Ave NW Ste a, Poulsbo, WA 98370Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Sygs Management LLC Organization, Brooklyn, NY LLC, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Oct 1, 2024 100%
Don Nguyen Individual W-2 Managing EmployeeMD; Oct 1, 2024
Samuel Stern Individual Contracted Managing EmployeeCeo Oct 1, 2024
5% Or Greater Indirect Ownership InterestCeo Oct 1, 2024 5%
Corporate OfficerCeo Oct 1, 2024
Corporate DirectorCeo Oct 1, 2024
Sygs 2023 Trust Organization, Brooklyn, NY 5% Or Greater Indirect Ownership Interest Oct 1, 2024 95%
Patrick Shepard Individual W-2 Managing EmployeeAd; Oct 1, 2024

Owners & managing parties with NPI records 1

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

  • Don Nguyen
    • Geriatric Medicine (Internal Medicine) Physician
    • Houston, TX
    • NPI 1720344617

    W-2 Managing Employee

    CMS ownership

Facilities with the same owner 9

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

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1728259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780963200000",
    "number": "1871312934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19352 VIKING AVE NW STE A",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983707276",
            "telephone_number": "360-994-1200",
            "fax_number": "360-824-6296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19352 VIKING AVE NW STE C",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983707276",
            "telephone_number": "510-499-9977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHALOM HOSPICE OF PUGET SOUND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-07",
        "last_updated": "2026-06-09",
        "certification_date": "2026-06-09",
        "status": "A",
        "authorized_official_last_name": "STERN",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "510-499-9977"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Poulsbo, WA

Sources for this page

Verify at the official NPI Registry.