Provider Demographics
NPI:1003633967
Name:SHACA HC LLC
Entity type:Organization
Organization Name:SHACA HC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EVANGELINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:909-904-9048
Mailing Address - Street 1:3281 E GUASTI RD STE 250
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7642
Mailing Address - Country:US
Mailing Address - Phone:909-457-2977
Mailing Address - Fax:323-900-0285
Practice Address - Street 1:445 PARK ST
Practice Address - Street 2:
Practice Address - City:WEED
Practice Address - State:CA
Practice Address - Zip Code:96094-2332
Practice Address - Country:US
Practice Address - Phone:530-938-4429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCKWELL HEALTHCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility