NPIMap

Organization Active NPI

Wesley Homes at Home, LLC

  • Home Health Agency
  • Seattle, WA
National Provider Identifier
1740312479
Registry record updated Jun 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
011286 Issued in WA
Legal business name
WESLEY HOMES AT HOME, LLC
Practice address
2111 N Northgate Way
Suite 103
Seattle, WA 98133-9018
Phone
(206) 870-1127
Fax
(206) 870-1339
NPI assigned
Mar 9, 2007
Last updated
Jun 6, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2008

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

Authorized official

Name
Mrs. Mary Kathryn Matteson
Title
Executive Director
Phone
(206) 870-1127

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 011286 WA Primary

Addresses

Primary practice location

2111 N Northgate Way
Suite 103
Seattle, WA 98133-9018

Mailing address

815 S 216TH St
Des Moines, WA 98198-6332
Phone (206) 870-1127

Other names 1

  • Wesley Homes Community Health Services Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070413000419 WA Part A Provider - Home Health Agency 0244335693 Practice locations: Des Moines, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740312479. Details of each certification follow.

Home health agency certification: CCN 507092

Legal name
WESLEY HOMES AT HOME, LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Nov 15, 1990
Last certification
Mar 12, 2021
Ownership / control type
Non-Profit
Organization structure
LLCNon-profit
Incorporated
Mar 6, 2007 in WA
Enrollment address
815 S 216TH St
Des Moines, WA 98198-4507

Care Compare: Home health agency

Medicare Care Compare
Listed as
Wesley Homes at Home, LLCCCN 507092 · All quality measures
Overall star rating
3.5 of 5
Ownership
Non-Profit
Certified
Nov 15, 1990
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kelly U Pajinag Individual Corporate DirectorExecutive Director Oct 9, 2023
W-2 Managing EmployeeExecutive Director Oct 9, 2023
Wesley Homes Community Health Services Organization, Des Moines, WA Non-profit 5% Or Greater Direct Ownership Interest May 1, 2007 100%
Operational/Managerial Control May 1, 2007 100%

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 20

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212710400000",
    "number": "1740312479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 S 216TH ST",
            "city": "DES MOINES",
            "state": "WA",
            "postal_code": "981986332",
            "telephone_number": "206-870-1127",
            "fax_number": "206-870-1339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2111 N NORTHGATE WAY",
            "address_2": "SUITE 103",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981339018",
            "telephone_number": "206-870-1127",
            "fax_number": "206-870-1339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESLEY HOMES AT HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2008-06-06",
        "status": "A",
        "authorized_official_last_name": "MATTESON",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "KATHRYN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "206-870-1127",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "WA",
            "license": "011286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wesley Homes Community Health Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.