Organization
VINE MAPLE CARE HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUZVIMINDA IMPERIAL MONAGHAN REGISTERED NURSE (OWNER/PROVIDER)
(253) 301-0099
Entity
Organization
Contact information
Practice address
12530 VINE MAPLE DR SW, LAKEWOOD, WA 98499-1134
(253) 301-0099
(253) 235-3645
Mailing address
12530 VINE MAPLE DR SW, LAKEWOOD, WA 98499-1134
(253) 301-0099
(253) 235-3645
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2107449
—
WA
Enumeration date
11/30/2018
Last updated
11/30/2018
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