# WILDERNESS SHORES NURSING, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073745113
- **Authorized official:** MRS. SHIRLEY ANN MCMONAGLE (ADMINISTRATOR)
- **Authorized official phone:** (206) 931-5284

## Contact information

- **Practice address:** 25614 LAKE WILDERNESS LN SE, MAPLE VALLEY, WA 98038-6019
- **Practice address phone:** (206) 931-5284
- **Practice address fax:** (425) 413-5116
- **Mailing address:** 25614 LAKE WILDERNESS LN SE, MAPLE VALLEY, WA 98038-6019
- **Mailing address phone:** (206) 931-5284
- **Mailing address fax:** (425) 413-5116

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | IHS.FS.60055610 | WA | Yes |

## Other

- **Enumeration date:** 08/21/2009
- **Last updated:** 08/21/2009