Healthcare Provider Details

I. General information

NPI: 1962197822
Provider Name (Legal Business Name): PNW HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 04/06/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 BROADWAY STE 500
TACOMA WA
98402-3499
US

IV. Provider business mailing address

P.O. BOX 5299 MS: 1313-5-PCO
TACOMA WA
98415
US

V. Phone/Fax

Practice location:
  • Phone: 253-301-6400
  • Fax: 253-301-6490
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM GLENN ROBERTSON
Title or Position: CEO
Credential:
Phone: 253-403-1272