Shelton Assisted Living

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

BH1447 Issued in WA

Legal business name

SHELTON ASSISTED LIVING

Doing business as

Maple Glen Assisted Living

Practice address

1700 N 13TH Loop Rd
Shelton, WA 98584-2167

Phone

(360) 427-0300

Fax

(360) 427-0303

NPI assigned

Apr 17, 2007

Organization subpart

No

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

Authorized official

Name

Kelley Crabtree

Title

Executive Director

Phone

(360) 427-0300

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Maple Glen Assisted Living Doing business as

Locations

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891911012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4610 NE 77TH AVE",
            "address_2": "SUITE #132",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626789",
            "telephone_number": "360-449-4524",
            "fax_number": "360-449-4525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 N 13TH LOOP RD",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985842167",
            "telephone_number": "360-427-0300",
            "fax_number": "360-427-0303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELTON ASSISTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CRABTREE",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "360-427-0300"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "WA",
            "license": "BH1447",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "938589",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maple Glen Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Shelton, WA
• Providers in Shelton, WA by specialty
• Assisted Living Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.