Healthcare Provider Details

I. General information

NPI: 1184446221
Provider Name (Legal Business Name): CP SNOHOMISH COUNTY WA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 75TH STREET SW SUITE 210
EVERETT WA
98203-6293
US

IV. Provider business mailing address

1341 W BATTLEFIELD SUITE 110
SPRINGFIELD MO
65807
US

V. Phone/Fax

Practice location:
  • Phone: 425-261-4800
  • Fax:
Mailing address:
  • Phone: 417-841-4834
  • Fax: 866-955-8538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: RUSSELL ADKINS
Title or Position: SVP, CHIEF LEGAL OFFICER
Credential:
Phone: 615-926-0340