| Shields For Families | |
|
11601 S Western Ave Los Angeles CA 90047-5006 | |
| (323) 242-5000 | |
| (323) 242-5011 |
| Full Name | Shields For Families |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 11601 S Western Ave, Los Angeles, California |
| Authorized Official Name and Position | Kathryn Icenhower (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 3232425000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shields For Families 11601 S Western Ave Los Angeles CA 90047-5006 Ph: (323) 242-5000 | Shields For Families 11601 S Western Ave Los Angeles CA 90047-5006 Ph: (323) 242-5000 |
| NPI Number | 1659506145 |
|---|---|
| Provider Enumeration Date | 05/27/2009 |
| Last Update Date | 04/10/2020 |
| Certification Date | 04/10/2020 |
| Medicare PECOS PAC ID | 3375723869 |
|---|---|
| Medicare Enrollment ID | O20110216000397 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659506145 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (California) | Primary |
| Provider Name | Maurice Weise |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043417264 PECOS PAC ID: 7113185794 Enrollment ID: I20120229000102 |
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