Healthcare Provider Details

I. General information

NPI: 1942820568
Provider Name (Legal Business Name): SIGNATURE HOME HEALTH BEND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 NE REVERE AVE
BEND OR
97701-4019
US

IV. Provider business mailing address

7632 SW DURHAM RD STE 105
TIGARD OR
97224-7597
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-5050
  • Fax: 541-527-1717
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MARY KOFSTAD
Title or Position: DIVISION PRESIDENT
Credential: NP
Phone: 971-224-2033