Provider Demographics
NPI:1114522703
Name:VASHON ISLAND ELDER CARE 2 INC
Entity Type:Organization
Organization Name:VASHON ISLAND ELDER CARE 2 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:DIAN
Authorized Official - Last Name:SHIPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:206-856-1670
Mailing Address - Street 1:PO BOX 513
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-0513
Mailing Address - Country:US
Mailing Address - Phone:206-856-1670
Mailing Address - Fax:
Practice Address - Street 1:7319 SW 258TH PL
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-8507
Practice Address - Country:US
Practice Address - Phone:206-856-1670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility