MEDICARE: SHALOM HOSPICE OF SOUTHWEST WASHINGTON 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	:	1174414833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHALOM HOSPICE OF SOUTHWEST WASHINGTON LLC

Provider Business Mailing Address
First Line	:	3205 NE 78TH ST STE 10
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98665-0697
Country	:	US
Telephone Number	:	360-302-4600
Fax Number	:	360-326-1572

Provider Business Practice Location Address
First Line	:	3205 NE 78TH ST STE 10
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98665-0697
Country	:	US
Telephone Number	:	360-302-4600
Fax Number	:	360-326-1572

Authorized Official
Title or Position	:	CEO
Name	:	SAMUEL STERN
Credential	:
Telephone Number	:	510-499-9977

Provider Enumeration Date	:	07/11/2025
Last Update Date	:	06/09/2026

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