Healthcare Provider Details

I. General information

NPI: 1932532512
Provider Name (Legal Business Name): SHIRELL'S HOME CARE CHANGING LIVES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9055 SANTA FE AVE E E 45
HESPERIA CA
92345-7968
US

IV. Provider business mailing address

9055 SANTA FE AVE E E 45
HESPERIA CA
92345-7968
US

V. Phone/Fax

Practice location:
  • Phone: 877-664-8588
  • Fax: 760-851-0995
Mailing address:
  • Phone: 877-664-8588
  • Fax: 760-851-0995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SHIRELL TIFFANY NEWSON
Title or Position: CEO
Credential: CSCM
Phone: 760-669-9707