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General NPI Number Information
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NPI Number | 1770760019
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Entity Type | Organization
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Legal Business Name | SHIRLEY'S CARE HOME INC #2
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 8351 HAMILTON WAY
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City | STOCKTON
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State | CA
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Zip | 95209-2212
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Country | US
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Telephone | 209-476-7582
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Fax | 209-952-7225
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Provider Business Mailing Address
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Address Line | 8351 HAMILTON WAY
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City | STOCKTON
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State | CA
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Zip | 95209-2212
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Country | US
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Telephone | 209-476-7582
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Fax | 209-952-7225
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | SHIRLEY GAPASIN
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Credential | RN
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Telephone | 209-607-8825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State | CA
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