MEDICARE: SHIELDS NURSING CENTERS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility
2	314000000X	Skilled Nursing Facility	140000139	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0651620002	OTHER	CA	DMERC

General Provider Information

NPI Number	:	1578559480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIELDS NURSING CENTERS INC

Provider Business Mailing Address
First Line	:	606 ALFRED NOBEL DR
Second Line	:
City	:	HERCULES
State	:	CA
Zip	:	94547-1834
Country	:	US
Telephone Number	:	510-924-9911
Fax Number	:	510-724-9922

Provider Business Practice Location Address
First Line	:	1919 CUTTING BLVD
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94804-2662
Country	:	US
Telephone Number	:	510-233-8513
Fax Number	:	510-233-8960

Authorized Official
Title or Position	:	CEO PRESIDENT
Name	:	MR. WILLIAM M SHIELDS JR.
Credential	:	ADMINISTRATOR
Telephone Number	:	510-724-9911

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	09/23/2022

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