Provider Demographics
NPI:1063656320
Name:SHIELD CALIFORNIA HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:SHIELD CALIFORNIA HEALTH CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CUSTOMER EXPERIENCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-294-4200
Mailing Address - Street 1:27911 FRANKLIN PKWY
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-4110
Mailing Address - Country:US
Mailing Address - Phone:661-294-4200
Mailing Address - Fax:
Practice Address - Street 1:615 STRANDER BLVD
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2922
Practice Address - Country:US
Practice Address - Phone:206-575-7837
Practice Address - Fax:206-575-6765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA09-1717332B00000X
332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9049404Medicaid
0374890010Medicare NSC