=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356164131
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHIELD CARERS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2024
-----------------------------------------------------
Last Update Date | 11/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 407 VALLEY AVE NE APT F306
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98372-2585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-393-8319
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 407 VALLEY AVE NE APT F306
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98372-2585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-393-8319
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MARGARET BUGONZI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-393-8319
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------