Healthcare Provider Details

I. General information

NPI: 1578400347
Provider Name (Legal Business Name): SHANGRILA HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

692 E PHILLIPS BLVD
POMONA CA
91766-4549
US

IV. Provider business mailing address

692 E PHILLIPS BLVD
POMONA CA
91766-4549
US

V. Phone/Fax

Practice location:
  • Phone: 626-318-8904
  • Fax:
Mailing address:
  • Phone: 626-318-8904
  • 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: MR. LUCIO COLLADO
Title or Position: CEO
Credential:
Phone: 626-318-8904