NPIMap

Organization Active NPI

Shield California Health Care Center, Inc.

  • Parenteral & Enteral Nutrition Supplies (DME)
  • Tukwila, WA
National Provider Identifier
1063656320
Registry record updated Jan 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Parenteral & Enteral Nutrition Supplies (DME)Taxonomy code 332BP3500X
Legal business name
SHIELD CALIFORNIA HEALTH CARE CENTER, INC.
Practice address
615 Strander Blvd
Tukwila, WA 98188-2922
Phone
(206) 575-7837
Fax
(206) 575-6765
NPI assigned
Apr 29, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mike Suor
Title
VP General Manager
Phone
(661) 294-4200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 09-1717 WA
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X Primary

Addresses

Primary practice location

615 Strander Blvd
Tukwila, WA 98188-2922

Mailing address

27911 Franklin Pkwy
Valencia, CA 91355-4110
Phone (661) 294-4200

Other identifiers 1

IdentifierTypeStateIssuer
9049404MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101109000919 WA DME Supplier - Medical Supply Company 7214055821 Practice locations: Tukwila, WA

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Shield California Health Care Cente615 Strander Blvd, Tukwila, WA 98188-2922(206) 575-7837 Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order)|Insulin Infusion Pumps and/or Supplies|Negative Pressure Wound Therapy Pumps/Supplies|Orthoses: Off-The-Shelf|Ostomy Supplies|Tracheotomy Supplies|Urological Supplies|Enteral Nut… Accepts assignmentParticipating since Jan 1, 2026

National Provider Directory

National Provider Directory
Tax ID family
Shield Hlthcr Ctrberke7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

615 Strander Blvd
Tukwila, WA 98188
Phone (206) 575-7837

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1240963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736812800000",
    "number": "1063656320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27911 FRANKLIN PKWY",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913554110",
            "telephone_number": "661-294-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 STRANDER BLVD",
            "city": "TUKWILA",
            "state": "WA",
            "postal_code": "981882922",
            "telephone_number": "206-575-7837",
            "fax_number": "206-575-6765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHIELD CALIFORNIA HEALTH CARE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-29",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A",
        "authorized_official_last_name": "SUOR",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "VP GENERAL MANAGER",
        "authorized_official_telephone_number": "661-294-4200"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WA",
            "license": "09-1717",
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9049404",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tukwila, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.