Provider Demographics
NPI:1417009507
Name:SHIRLEY'S CARE HOME
Entity Type:Organization
Organization Name:SHIRLEY'S CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GAPASIN
Authorized Official - Suffix:
Authorized Official - Credentials:
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:209-607-9380
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:209-607-9380
Practice Address - Fax:209-952-7825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05G976Medicaid
CA55G247Medicaid
CA55G509Medicaid
CA55G389Medicaid