SHIRLEY'S ICF DD N NO 5 NPI 1053563536

NPI Details

SHIRLEY'S ICF DD N NO 5 is a nursing facility intermediate care facility in Stockton, CA. The provider is an institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. SHIRLEY'S ICF DD N NO 5 NPI is 1053563536. The provider is registered as an organization entity type.

The provider's business location address is:

9565 COLINGTON PL
STOCKTON, CA
ZIP 95209-013
Phone: (209) 952-6027
Fax: (209) 952-7829

The provider's authorized official is Shirley E Gapasin .
The authorized official title is Chief Financial Officer and has the following contact phone number (209) 607-9380.

The CLIA number assigned to this NPI record is 05D1086638 - intermediate care facility for mentally retarded with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/16/2008 and was last updated on 10/16/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.