NPIMap

Organization Active NPI

Shirley'S Care Home

  • Nursing Facility/Intermediate Care Facility
  • Stockton, CA
National Provider Identifier
1417009507
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
Legal business name
SHIRLEY'S CARE HOME
Practice address
9565 Colington PL
Stockton, CA 95209-5013
Phone
(209) 607-9380
Fax
(209) 952-7825
NPI assigned
Jan 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Shirley E Gapasin
Title
President
Phone
(209) 607-9380

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X CA Primary

Addresses

Primary practice location

9565 Colington PL
Stockton, CA 95209-5013

Mailing address

9565 Colington PL
Stockton, CA 95209-5013
Phone (209) 607-9380

Other identifiers 4

IdentifierTypeStateIssuer
05G976MedicaidCA
55G247MedicaidCA
55G509MedicaidCA
55G389MedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Shirley'S Care Home Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417009507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9565 COLINGTON PL",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952095013",
            "telephone_number": "209-607-9380",
            "fax_number": "209-952-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9565 COLINGTON PL",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952095013",
            "telephone_number": "209-607-9380",
            "fax_number": "209-952-7825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHIRLEY'S CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GAPASIN",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-607-9380",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05G976",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "55G247",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "55G509",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "55G389",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.