Provider Demographics
NPI:1245415272
Name:SHIRLEY'S CARE HOME INC
Entity Type:Organization
Organization Name:SHIRLEY'S CARE HOME INC
Other - Org Name:SHIRLEY'S ICF DD H NO 4
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAPASIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:209-607-9380
Mailing Address - Street 1:9565 COLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-5013
Mailing Address - Country:US
Mailing Address - Phone:209-952-6027
Mailing Address - Fax:209-952-7825
Practice Address - Street 1:9565 COLINGTON PL
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-5013
Practice Address - Country:US
Practice Address - Phone:209-952-6027
Practice Address - Fax:209-952-7825
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55G501Medicare Oscar/Certification