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General NPI Number Information
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NPI Number | 1962890053
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Entity Type | Organization
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Legal Business Name | HERO'S SHELTER INC.
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Dates
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Enumeration Date | 12/26/2014
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 3646 OCEAN RANCH BLVD
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City | OCEANSIDE
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State | CA
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Zip | 92056-2669
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Country | US
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Telephone | 571-400-8461
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 558
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City | SAN LUIS REY
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State | CA
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Zip | 92068-0558
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Country | US
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Telephone | 571-400-8461
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Fax |
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Authorized Official
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Title or Position | HEALTH SERVICES EXECUTIVE
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Name | MS. OLUWAPELUMI OLUKOTUN
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Credential | BSN, MSHA, APRN, CCM
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Telephone | 571-400-8461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management 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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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Taxonomy #3
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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Taxonomy #4
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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Taxonomy #5
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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Taxonomy #6
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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Taxonomy #7
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number |
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Taxonomy #8
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Taxonomy Code | 282J00000X
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Taxonomy Name | Religious Nonmedical Health Care Institution
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License Number |
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Taxonomy #9
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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Taxonomy #10
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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