Healthcare Provider Details

I. General information

NPI: 1215877667
Provider Name (Legal Business Name): SHIELD CARE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2026
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 TRULYN AVE
MANTECA CA
95337-8131
US

IV. Provider business mailing address

1923 TRULYN AVE
MANTECA CA
95337-8131
US

V. Phone/Fax

Practice location:
  • Phone: 408-821-5552
  • Fax:
Mailing address:
  • Phone: 408-821-5552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: SHARON DREQUITO
Title or Position: ADMINISTRATOR
Credential:
Phone: 408-821-5552