Provider Demographics
NPI:1932702156
Name:VASHON ISLAND ELDER CARE
Entity Type:Organization
Organization Name:VASHON ISLAND ELDER CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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 1:17311 96TH PL SW
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-4933
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:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home