Healthcare Provider Details

I. General information

NPI: 1669399754
Provider Name (Legal Business Name): OCTOPUS COMMUNITY CARE NETWORK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 N CENTRAL AVE STE 610
GLENDALE CA
91203-3533
US

IV. Provider business mailing address

229 N CENTRAL AVE STE 610
GLENDALE CA
91203-3533
US

V. Phone/Fax

Practice location:
  • Phone: 310-331-2902
  • Fax: 888-414-7839
Mailing address:
  • Phone: 310-331-2902
  • Fax: 888-414-7839

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: SHELLYDALE P GRAY
Title or Position: CEO/ADMINISTRATOR
Credential: ADMINISTRATION
Phone: 310-331-2902