Healthcare Provider Details

I. General information

NPI: 1932038577
Provider Name (Legal Business Name): MAGNOLIA SENIOR CARE OF HIGHLINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 S 244TH ST
DES MOINES WA
98198-4986
US

IV. Provider business mailing address

13123 SE 230TH PL
KENT WA
98031-5665
US

V. Phone/Fax

Practice location:
  • Phone: 206-429-2275
  • Fax: 206-429-2257
Mailing address:
  • Phone: 619-335-7716
  • Fax: 206-429-2257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL MOGES
Title or Position: PROVIDER
Credential:
Phone: 619-335-7716