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General NPI Number Information
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NPI Number | 1528276276
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Entity Type | Organization
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Legal Business Name | SHEPHERD MANOR HOSPICELLC
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 09/21/2007
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Provider Practice Location Address
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Address Line | 13017 ARTESIA BLVD SUITE 120D
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City | CERRITOS
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State | CA
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Zip | 90703-1364
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Country | US
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Telephone | 562-900-4563
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Fax |
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Provider Business Mailing Address
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Address Line | 15522 WILDER AVE
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City | NORWALK
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State | CA
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Zip | 90650-7345
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Country | US
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Telephone | 562-900-4563
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Fax |
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Authorized Official
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Title or Position | MANAGERMEMBER
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Name | DR. BRENDA SHEPPARDJOHNSON
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Credential |
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Telephone | 562-900-4563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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