Provider Demographics
NPI:1710288931
Name:SHIMAREE FOSTER
Entity Type:Organization
Organization Name:SHIMAREE FOSTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/TREAMENT NURSE/SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SHIMAREE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-689-2340
Mailing Address - Street 1:PO BOX 494
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92502-0494
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3766 NYE AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-1867
Practice Address - Country:US
Practice Address - Phone:951-689-2340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2011-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN231776314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility