PNW Hospice, LLC
Organization Active NPI Community Based Hospice Care Agency · Tacoma, WA
NPI 1962197822 · NPPES record last updated Apr 6, 2023
Key facts
- NPI
- 1962197822
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- PNW HOSPICE, LLC
- Practice address
- 1313 Broadway Ste 500
Tacoma, WA 98402-3499 - Phone
- (253) 301-6400
- Fax
- (253) 301-6490
- NPI assigned
- Apr 6, 2023
- Organization subpart
- No
Authorized official
- Name
- William Glenn Robertson
- Title
- Ceo
- Phone
- (253) 403-1272
Owners & managing parties with NPI records 2
-
Tariq Salam, MD
Member of 1
Facilities with the same owner 20
Affiliated clinicians 1
-
Naji Alhasnawi, MD
Medicare Care Compare: Hospice
- Listed as
- PNW Hospice LLC
- Certified
- Apr 10, 2024
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 50D2288406 | PNW Hospice | Certificate of waiver | Apr 4, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
Hospice certification: CCN 501555
- Legal name
- PNW HOSPICE LLC
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Apr 10, 2024
- Last certification
- Apr 4, 2024
- Organization structure
- LLC · Proprietary
- Incorporated
- Nov 30, 2020 in WA
- Enrollment address
- 1313 Broadway
Ste 500
Tacoma, WA 98402-3499
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Donald Thompson |
W-2 Managing Employee |
May 3, 2023 | |
| William G Robertson |
Corporate Officer |
May 1, 2014 | |
| W-2 Managing Employee |
Apr 1, 2014 | ||
| Melissa Chubbuck |
W-2 Managing Employee |
May 3, 2023 | |
| Leslie Dale Sowell |
Corporate Director | Jan 1, 2001 | |
| Robert Yost |
Corporate Director | Jan 1, 2006 | |
| John Wiborg |
Corporate Director | Jan 1, 2002 | |
| Tariq Salam |
Corporate Director | Nov 1, 2020 | |
| W-2 Managing Employee | Nov 1, 2020 | ||
| James Gyeong-Jin Lee |
Corporate Officer |
Jun 1, 2022 | |
| W-2 Managing Employee |
Jun 1, 2022 | ||
| Tara Perry |
Corporate Director | Aug 25, 2021 | |
| Florence Chang |
Corporate Officer |
Apr 1, 2015 | |
| W-2 Managing Employee |
Jan 1, 2015 | ||
| Robin J Thomashauer |
Corporate Director | Nov 1, 2020 | |
| Janine Terrano |
Corporate Director | Jan 1, 2013 | |
| Frank Tombari |
Corporate Director | Jan 28, 2022 | |
| Deedee Walkey |
Corporate Director | Jan 1, 2010 | |
| Sally Leighton |
Corporate Director | Jan 1, 2001 | |
| Multicare Health System |
5% Or Greater Direct Ownership Interest | May 3, 2023 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240118002727 | WA | Part a Provider - Hospice | 7315399052 | Practice locations: Tacoma, WA |
National Provider Directory
Locations
1313 Broadway
Ste 500
Tacoma, WA 98402
Phone (253) 301-6400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
1313 Broadway Ste 500
Tacoma, WA 98402-3499
Mailing address
P.O. Box 5299
Ms: 1313-5-Pco
Tacoma, WA 98415
Other providers in Tacoma, WA
- Lisa Catherine Plymate
- PNW Eye PLLC
- PNW Eye, PLLC
- PNW Family Medical Care PLLC
- PNW Happy Healthy, PLLC
- PNW Pace Partners, LLC
- PNW Speech and Language LLC
- Laura Ndem Poci
- Patrick Podrazik
- Bailey Dawn Poe
All providers in Tacoma, WA · Community Based Hospice Care Agency in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 6, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.