NPIMap

Organization Active NPI

Vine Maple Care Home LLC

  • Adult Care Home Facility
  • Lakewood, WA
National Provider Identifier
1154891224
Registry record updated Nov 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Care Home FacilityTaxonomy code 311ZA0620X
Legal business name
VINE MAPLE CARE HOME LLC
Practice address
12530 Vine Maple Dr SW
Lakewood, WA 98499-1134
Phone
(253) 301-0099
Fax
(253) 235-3645
NPI assigned
Nov 30, 2018
Last updated
Nov 30, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2018

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

Authorized official

Name
Luzviminda Imperial Monaghan, REGISTERED NURSENPI 1154891984
Title
Owner/Provider
Phone
(253) 301-0099

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X NU Primary

Addresses

Primary practice location

12530 Vine Maple Dr SW
Lakewood, WA 98499-1134

Mailing address

12530 Vine Maple Dr SW
Lakewood, WA 98499-1134
Phone (253) 301-0099

Other identifiers 1

IdentifierTypeStateIssuer
2107449MedicaidWA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2277173Vine Maple Care Home LLC12530 Vine Maple Dr SW, Lakewood, WA 98499Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Locations

12530 Vine Maple Dr SW
Lakewood, WA 98499
Phone (253) 292-7698

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1543536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543536000000",
    "number": "1154891224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12530 VINE MAPLE DR SW",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984991134",
            "telephone_number": "253-301-0099",
            "fax_number": "253-235-3645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12530 VINE MAPLE DR SW",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984991134",
            "telephone_number": "253-301-0099",
            "fax_number": "253-235-3645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VINE MAPLE CARE HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-30",
        "last_updated": "2018-11-30",
        "status": "A",
        "authorized_official_last_name": "MONAGHAN",
        "authorized_official_first_name": "LUZVIMINDA",
        "authorized_official_middle_name": "IMPERIAL",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "253-301-0099",
        "authorized_official_credential": "REGISTERED NURSE"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2107449",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.