Healthcare Provider Details

I. General information

NPI: 1003633967
Provider Name (Legal Business Name): SHACA HC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 PARK ST
WEED CA
96094-2332
US

IV. Provider business mailing address

3281 E GUASTI RD STE 250
ONTARIO CA
91761-7642
US

V. Phone/Fax

Practice location:
  • Phone: 530-938-4429
  • Fax:
Mailing address:
  • Phone: 909-457-2977
  • Fax: 323-900-0285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: EVANGELINE R POWELL
Title or Position: CEO
Credential: RN
Phone: 909-904-9048