=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063656320
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHIELD CALIFORNIA HEALTH CARE CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2009
-----------------------------------------------------
Last Update Date | 01/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 615 STRANDER BLVD
-----------------------------------------------------
City | TUKWILA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98188-2922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-575-7837
-----------------------------------------------------
Fax | 206-575-6765
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27911 FRANKLIN PKWY
-----------------------------------------------------
City | VALENCIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91355-4110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-294-4200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP GENERAL MANAGER
-----------------------------------------------------
Name | MIKE SUOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 661-294-4200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 09-1717
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332BP3500X
-----------------------------------------------------
Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------