Provider Demographics
NPI:1578559480
Name:SHIELDS NURSING CENTERS INC
Entity Type:Organization
Organization Name:SHIELDS NURSING CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:510-724-9911
Mailing Address - Street 1:606 ALFRED NOBEL DR
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1834
Mailing Address - Country:US
Mailing Address - Phone:510-924-9911
Mailing Address - Fax:510-724-9922
Practice Address - Street 1:1919 CUTTING BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-2662
Practice Address - Country:US
Practice Address - Phone:510-233-8513
Practice Address - Fax:510-233-8960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000139314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05292JMedicaid
CA0651620002OtherDMERC
CA0651620002OtherDMERC
CAZZR05292JMedicaid