1639201031 NPI number — SHIELDS FOR FAMILIES

Table of content: (NPI 1639201031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639201031 NPI number — SHIELDS FOR FAMILIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHIELDS FOR FAMILIES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639201031
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/12/2019
NPI Reactivation Date:
11/13/2019

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11601 S WESTERN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90047-5006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-242-5000
Provider Business Mailing Address Fax Number:
323-242-5011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2620 INDUSTRY WAY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LYNWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90262-4024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-242-5000
Provider Business Practice Location Address Fax Number:
323-242-5011
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ICENHOWER
Authorized Official First Name:
KATHRYN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
323-242-5000

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7365 . This is a "MEDI-CAL PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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