Provider Demographics
NPI:1932532512
Name:SHIRELL'S HOME CARE CHANGING LIVES LLC
Entity Type:Organization
Organization Name:SHIRELL'S HOME CARE CHANGING LIVES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHIRELL
Authorized Official - Middle Name:TIFFANY
Authorized Official - Last Name:NEWSON
Authorized Official - Suffix:
Authorized Official - Credentials:CSCM
Authorized Official - Phone:760-669-9707
Mailing Address - Street 1:9055 SANTA FE AVE E
Mailing Address - Street 2:E 45
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-7968
Mailing Address - Country:US
Mailing Address - Phone:877-664-8588
Mailing Address - Fax:760-851-0995
Practice Address - Street 1:9055 SANTA FE AVE E
Practice Address - Street 2:E 45
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-7968
Practice Address - Country:US
Practice Address - Phone:877-664-8588
Practice Address - Fax:760-851-0995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251F00000XAgenciesHome Infusion
No251G00000XAgenciesHospice Care, Community Based