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General NPI Number Information
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NPI Number | 1376368035
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Entity Type | Organization
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Legal Business Name | SHIELDS FOUNDATION LLC
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 4000 FABER PLACE DR STE 300
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City | CHARLESTON
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State | SC
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Zip | 29405-8587
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Country | US
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Telephone | 720-746-9254
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Fax |
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Provider Business Mailing Address
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Address Line | 2253 S ONEIDA ST STE 201
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City | DENVER
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State | CO
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Zip | 80224-2562
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Country | US
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Telephone | 720-746-9254
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | ROBERT PLOWDEN
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Credential |
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Telephone | 720-746-9254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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