MEDICARE: SIGNATURE HOSPICE PORTLAND, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1154902831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIGNATURE HOSPICE PORTLAND, LLC

Provider Business Mailing Address
First Line	:	7632 SW DURHAM RD STE 105
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97224-7597
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7632 SW DURHAM RD STE 130
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97224-7584
Country	:	US
Telephone Number	:	800-936-4756
Fax Number	:	503-682-3989

Authorized Official
Title or Position	:	DIVISION PRESIDENT
Name	:	MARY KOFSTAD
Credential	:	NP
Telephone Number	:	971-224-2033

Provider Enumeration Date	:	04/15/2021
Last Update Date	:	11/13/2025

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