VINE MAPLE CARE HOME LLC NPI 1154891224

NPI Information

  • NPI: 1154891224
  • Provider Name: VINE MAPLE CARE HOME LLC
  • Classification: Custodial Care Facility - 311ZA0620X
  • Specialization: Adult Care Home
  • Entity Type: Organization
  • CLIA Number: 50D2277173
  • Address: 12530 VINE MAPLE DR SW
    LAKEWOOD, WA
    ZIP 98499
  • Phone: (253) 301-0099

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NPI Details

VINE MAPLE CARE HOME LLC is an adult care home custodial care facility in Lakewood, WA. The provider is 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. VINE MAPLE CARE HOME LLC NPI is 1154891224. The provider is registered as an organization entity type.

The provider's business location address is:

12530 VINE MAPLE DR SW
LAKEWOOD, WA
ZIP 98499-134
Phone: (253) 301-0099
Fax: (253) 235-3645

The provider's authorized official is Luzviminda Imperial Monaghan .
The authorized official title is Owner/provider and has the following contact phone number (253) 301-0099.

The CLIA number assigned to this NPI record is 50D2277173 - other - afh with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/30/2018 and was last updated on 11/30/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1311ZA0620XCustodial Care FacilityAdult Care HomeYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12107449MEDICAIDWASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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