Wilderness Shores Nursing, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

IHS.FS.60055610 Issued in WA

Legal business name

WILDERNESS SHORES NURSING, LLC

Practice address

25614 Lake Wilderness LN SE
Maple Valley, WA 98038-6019

Phone

(206) 931-5284

Fax

(425) 413-5116

NPI assigned

Aug 21, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Shirley Ann McMonagle

Title

Administrator

Phone

(206) 931-5284

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1250812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250812800000",
    "number": "1073745113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25614 LAKE WILDERNESS LN SE",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980386019",
            "telephone_number": "206-931-5284",
            "fax_number": "425-413-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25614 LAKE WILDERNESS LN SE",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980386019",
            "telephone_number": "206-931-5284",
            "fax_number": "425-413-5116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDERNESS SHORES NURSING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-21",
        "last_updated": "2009-08-21",
        "status": "A",
        "authorized_official_last_name": "MCMONAGLE",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "206-931-5284",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "WA",
            "license": "IHS.FS.60055610",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bianca Whealton, L.M.P.
• Jazmine Faye Whitaker
• Douglas Farrelly Whitfield, DDS
• Grace Raechel Whorley, LMHC
• Daron Wicker, MA, LMHCA
• Wilderness Shores Supplies, LLC
• Kristin Marie Wilkins, DPT
• Ethan Wilson, LMP
• Within Pelvic Health PT, PLLC
• Brianna Llyn Wood, M.A.

• Home Health Agency in Maple Valley, WA
• Providers in Maple Valley, WA by specialty
• Home Health Agency in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.