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General NPI Number Information
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NPI Number | 1932532512
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Entity Type | Organization
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Legal Business Name | SHIRELL'S HOME CARE CHANGING LIVES LLC
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Dates
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Enumeration Date | 08/19/2013
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Last Update Date | 10/22/2013
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Provider Practice Location Address
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Address Line | 9055 SANTA FE AVE E E 45
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City | HESPERIA
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State | CA
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Zip | 92345-7968
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Country | US
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Telephone | 877-664-8588
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Fax | 760-851-0995
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Provider Business Mailing Address
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Address Line | 9055 SANTA FE AVE E E 45
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City | HESPERIA
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State | CA
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Zip | 92345-7968
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Country | US
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Telephone | 877-664-8588
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Fax | 760-851-0995
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Authorized Official
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Title or Position | CEO
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Name | SHIRELL TIFFANY NEWSON
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Credential | CSCM
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Telephone | 760-669-9707
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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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Taxonomy #2
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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