Provider Demographics
NPI:1144690876
Name:SKAGIT HOSPICE SERVICES, LLC
Entity type:Organization
Organization Name:SKAGIT HOSPICE SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:C
Authorized Official - Last Name:LITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-814-8346
Mailing Address - Street 1:227 FREEWAY DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2886
Mailing Address - Country:US
Mailing Address - Phone:360-814-5550
Mailing Address - Fax:360-814-5591
Practice Address - Street 1:227 FREEWAY DR
Practice Address - Street 2:SUITE A
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2886
Practice Address - Country:US
Practice Address - Phone:360-814-5550
Practice Address - Fax:360-814-5591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.00000437207Q00000X, 363L00000X, 363LA2100X, 363LG0600X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty