Provider Demographics
NPI:1205983517
Name:VASHON ISLAND COMMUNITY CARE
Entity type:Organization
Organization Name:VASHON ISLAND COMMUNITY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ANSELL
Authorized Official - Suffix:
Authorized Official - Credentials:NHA00002425
Authorized Official - Phone:206-567-4421
Mailing Address - Street 1:15333 VASHON HWY SW
Mailing Address - Street 2:
Mailing Address - City:VASHON ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98070-3831
Mailing Address - Country:US
Mailing Address - Phone:206-567-4421
Mailing Address - Fax:206-567-5052
Practice Address - Street 1:15333 VASHON HWY SW
Practice Address - Street 2:
Practice Address - City:VASHON ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98070-3831
Practice Address - Country:US
Practice Address - Phone:206-567-4421
Practice Address - Fax:206-567-5052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1331314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4113312Medicaid
WA114267OtherDSHS-COPES BOARDING HOME#
WA993197OtherDSHS-COPES ADULT DAY PROG
WA114267OtherDSHS-COPES BOARDING HOME#