Provider Demographics
NPI:1154902831
Name:SIGNATURE HOSPICE PORTLAND, LLC
Entity type:Organization
Organization Name:SIGNATURE HOSPICE PORTLAND, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIVISION PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOFSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:971-224-2033
Mailing Address - Street 1:7632 SW DURHAM RD STE 105
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7597
Mailing Address - Country:US
Mailing Address - Phone:844-744-2200
Mailing Address - Fax:
Practice Address - Street 1:7632 SW DURHAM RD STE 130
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7584
Practice Address - Country:US
Practice Address - Phone:800-936-4756
Practice Address - Fax:503-682-3989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based