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General NPI Number Information
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NPI Number | 1124132154
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Entity Type | Organization
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Legal Business Name | SHIELD DENVER HEALTH CARE CENTER INC
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 847 N CHURCH CT UNIT A
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City | ELMHURST
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State | IL
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Zip | 60126-1036
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Country | US
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Telephone | 630-530-3657
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Fax | 630-617-5218
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Provider Business Mailing Address
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Address Line | 27911 FRANKLIN PKWY
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City | VALENCIA
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State | CA
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Zip | 91355-4110
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Country | US
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Telephone | 661-294-4200
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Fax | 661-294-1042
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Authorized Official
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Title or Position | VP AND GENERAL MANAGER
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Name | MIKE SUOR
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Credential |
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Telephone | 661-294-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 06 02581
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 06 02581
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License Number State | IL
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