Healthcare Provider Details

I. General information

NPI: 1871206441
Provider Name (Legal Business Name): SHIELDS SKILLED CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3408 E SHIELDS AVE
FRESNO CA
93726-6907
US

IV. Provider business mailing address

1817 AVENIDA DEL DIABLO
ESCONDIDO CA
92029-3112
US

V. Phone/Fax

Practice location:
  • Phone: 559-227-4063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SCOTT KIRBY
Title or Position: MANAGER
Credential:
Phone: 619-201-5888