NPIMap

Organization Active NPI

Wesley Homes Hospice, LLC

  • Community Based Hospice Care Agency
  • Des Moines, WA
National Provider Identifier
1851831994
Registry record updated Jul 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
IHS.FS.60276500 Issued in WA
Legal business name
WESLEY HOMES HOSPICE, LLC
Practice address
815 S 216TH St
Des Moines, WA 98198-6332
Phone
(206) 870-1127
Fax
(206) 870-4165
NPI assigned
Mar 7, 2017
Organization subpart
Yes
Parent organization
WESLEY HOMES COMMUNITY HEALTH SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 13, 2021

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

Authorized official

Name
Melinda Moore
Title
Executive Director
Phone
(206) 870-1118

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X IHS.FS.60276500 WA Primary
Community Based Hospice Care Agency 251G00000X

Addresses

Primary practice location

815 S 216TH St
Des Moines, WA 98198-6332

Mailing address

18000 72ND Ave S Ste 217
Kent, WA 98032-1035
Phone (206) 870-1127

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170428000046 WA Part A Provider - Hospice 2365729423 Practice locations: Kent, WA

Hospice certification: CCN 501543

Legal name
WESLEY HOMES HOSPICE, LLC
Doing business as
WESLEY HOMES HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Nov 2, 2017
Last certification
May 19, 2021
Ownership / control type
Non-Profit - Private
Organization structure
LLCNon-profit
Incorporated
Nov 14, 2016 in WA
Enrollment address
18000 72ND Ave S
Ste 217
Kent, WA 98032-1035

Care Compare: Hospice

Medicare Care Compare
Listed as
Wesley Homes Hospice, LLCCCN 501543
Ownership
Non-Profit
Certified
Nov 2, 2017
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Wesley Homes Hospice LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Kevin Anderson Individual W-2 Managing EmployeePresident and Ceo Jan 1, 2000 50%
Cheri Keiler Individual Corporate Director Jun 1, 2021 25%
Melinda Moore Individual Corporate OfficerExecutive Director Jun 1, 2015 50%
Jill Poleskie Individual Corporate Director May 1, 2021 25%
Richard Jobst Individual Corporate Director May 1, 2021 25%
Wesley Homes Community Health Services Organization, Des Moines, WA Corporation 5% Or Greater Direct Ownership Interest Apr 1, 2003 100%
Dennis Larry Magnuson Individual Corporate Director Jun 1, 2021 25%

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 2

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

NPI Registry JSON

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

{
    "created_epoch": "1488844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626134400000",
    "number": "1851831994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18000 72ND AVE S STE 217",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980321035",
            "telephone_number": "206-870-1127",
            "fax_number": "206-870-4165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 S 216TH ST",
            "city": "DES MOINES",
            "state": "WA",
            "postal_code": "981986332",
            "telephone_number": "206-870-1127",
            "fax_number": "206-870-4165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESLEY HOMES HOSPICE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WESLEY HOMES COMMUNITY HEALTH SERVICES",
        "enumeration_date": "2017-03-07",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "MELINDA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "206-870-1118"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "WA",
            "license": "IHS.FS.60276500",
            "primary": true
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, WA

Sources for this page

Verify at the official NPI Registry.