Healthcare Provider Details

I. General information

NPI: 1942141619
Provider Name (Legal Business Name): SHORELINE SENIOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2026
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

879 W 190TH ST STE 400
GARDENA CA
90248-4223
US

IV. Provider business mailing address

879 W 190TH ST STE 400
GARDENA CA
90248-4223
US

V. Phone/Fax

Practice location:
  • Phone: 424-488-8821
  • Fax: 424-435-4244
Mailing address:
  • Phone: 424-488-8821
  • Fax: 424-435-4244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY HENG-LU
Title or Position: OWNER
Credential:
Phone: 858-610-9363