=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174345193
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CP SEATTLE WA HOSPICE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2024
-----------------------------------------------------
Last Update Date | 10/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2811 S 102ND STREET SUITE 220
-----------------------------------------------------
City | TUKWILA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98168-1869
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-320-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1341 W BATTLEFIELD SUITE 110
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-841-4834
-----------------------------------------------------
Fax | 866-955-8538
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SVP, CHIEF LEGAL OFFICER
-----------------------------------------------------
Name | RUSSELL ADKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-926-0340
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------