MEDICARE: SHUTES & LEE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility		CA

General Provider Information

NPI Number	:	1093934101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHUTES & LEE, INC

Provider Business Mailing Address
First Line	:	1443 S GENESEE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-3702
Country	:	US
Telephone Number	:	323-935-2244
Fax Number	:	323-939-1069

Provider Business Practice Location Address
First Line	:	1443 S GENESEE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-3702
Country	:	US
Telephone Number	:	323-935-2244
Fax Number	:	323-939-1069

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. BELINDA LEE
Credential	:
Telephone Number	:	323-935-2244

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	08/22/2020

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Directions to “SHUTES & LEE, INC ” Practice Location

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