VINE MAPLE CARE HOME LLC (NPI# 1154891224) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154891224 |
| Entity Type | Organization |
| Organization Name | VINE MAPLE CARE HOME LLC |
| Practice Address |
12530 Vine Maple Dr Sw Lakewood WA 98499-1134 |
| Practice Telephone | 2533010099 |
| Practice Fax Number | 2532353645 |
| Mailing Telephone | 2533010099 |
| Mailing Fax Number | 2532353645 |
| Enumeration Date | 2018-11-30 |
| Last Update Date | 2018-11-30 |
| Authorized Official Name | LUZVIMINDA IMPERIAL MONAGHAN (OWNER/PROVIDER) |
| Authorized Official Telephone | 2533010099 |
| Authorized Official Credential | REGISTERED NURSE |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 2107449 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | VINE MAPLE CARE HOME LLC | 12530 Vine Maple Dr Sw, Lakewood, WA 98499 |
| Street Address |
12530 VINE MAPLE DR SW |
| City | LAKEWOOD |
| State | WA |
| Zip Code | 98499-1134 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912477001 | Maria Cristina Walsh | Registered Nurse | 12530 Vine Maple Dr Sw, Lakewood, WA 98499-1134 | 2018-11-30 |
| 1154891984 | Luzviminda Imperial Monaghan | Registered Nurse | 12530 Vine Maple Dr Sw, Lakewood, WA 98499-1134 | 2018-12-05 |
| 1174093207 | Antonia C Wilson | Registered Nurse | 12530 Vine Maple Dr Sw, Lakewood, WA 98499-1134 | 2018-12-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275159592 | Sea Mar Community Health Centers | Clinic/Center | 5700 100th Street Se, Suite 510, Lakewood, WA 98499 | 2020-06-23 |
| 1568018828 | Heather Leigh Andrade | Behavioral Analyst | 6210 75th St W Ste 100, Lakewood, WA 98499 | 2019-08-13 |
| 1043870876 | Seoul Chinese Herbs Inc | Acupuncturist | 8705 S. Tacoma Way, Lakewood, WA 98499 | 2019-06-14 |
| 1013572064 | Puget Sound Kidney Centers | Clinic/Center | 11950 47th Ave Sw, Lakewood, WA 98499 | 2019-05-06 |
| 1447736657 | Marcela Cunan | Counselor | 9330 59th Avenue Southest, Lakewood, WA 98499 | 2018-07-11 |
| 1609382381 | Leroy Moore IIi | Counselor | 8811 S. Tacoma Way, 106, Lakewood, WA 98499 | 2017-12-18 |
| 1578077657 | Andrea Gaston | Behavior Technician | 8815 S. Tacoma Way, Suite 122, Lakewood, WA 98499 | 2017-11-27 |
| 1609389931 | Jennifer King | Social Worker | 5900 100th St Sw Ste 17b, Lakewood, WA 98499 | 2017-11-08 |
| 1750806337 | Wonyoung Lee | Counselor | 8811 South Tacoma Way, Suite 106, Lakewood, WA 98499 | 2017-08-04 |
| 1043749443 | Frederick Paltron Edwards | Counselor | 9500 Front Street, Suite 100, Lakewood, WA 98499 | 2017-06-08 |
| Find all providers in zip 98499 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649877952 | Chase House LLC | Custodial Care Facility | 7006 Opal Ct Sw, Lakewood, WA 98498-6408 | 2020-10-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043810534 | Apple Creek, Inc. | Custodial Care Facility | 513 W Washington Ave, Yakima, WA 98903-1308 | 2020-10-26 |
| 1821603275 | Maria Sigheartau | Custodial Care Facility | 16228 Ne 100th St, Redmond, WA 98052-3039 | 2020-09-12 |
| 1154947802 | Allan's Place Extended Comfort Care LLC | Custodial Care Facility | 3134 E 15th Ave, Spokane, WA 99223-5110 | 2020-06-18 |
| 1780205633 | Dina Grib | Custodial Care Facility | 31408 8th Ave S, Federal Way, WA 98003-5302 | 2020-05-01 |
| 1699307769 | Jane Thuo | Custodial Care Facility | 11722 Ne 134th St, Kirkland, WA 98034-2130 | 2020-02-06 |
| 1982244034 | Careplus Adult Family Home Inc | Custodial Care Facility | 1923 149th St Sw, Lynnwood, WA 98087-6310 | 2020-01-07 |
| 1548804578 | Aurita Estudillo Tagle | Custodial Care Facility | 7015 Carolina Ln, Vancouver, WA 98664-1558 | 2019-11-02 |
| 1841846409 | Genteel Inc | Custodial Care Facility | 781 Kaynor Rd, Ellensburg, WA 98926-8691 | 2019-08-09 |
| 1114589033 | Deborah Nordberg | Custodial Care Facility | 203 S 77th Ave, Yakima, WA 98908-1513 | 2019-07-01 |
| 1992360523 | Lilian Malamusha | Custodial Care Facility | 10511 E 8th Ave, Spokane Valley, WA 99206-3506 | 2019-05-09 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on VINE MAPLE CARE HOME LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.