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General NPI Number Information
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NPI Number | 1184208589
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Entity Type | Organization
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Legal Business Name | SIGNATURE HOSPICE NAMPA, LLC
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Dates
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Enumeration Date | 05/11/2021
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 3904 E FLAMINGO AVE STE 100
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City | NAMPA
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State | ID
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Zip | 83687-3144
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Country | US
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Telephone | 208-465-7121
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Fax | 208-461-7979
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Provider Business Mailing Address
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Address Line | 7632 SW DURHAM RD STE 105
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City | TIGARD
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State | OR
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Zip | 97224-7597
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIVISION PRESIDENT
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Name | MARY KOFSTAD
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Credential | NP
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Telephone | 971-224-2033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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