| Shields For Families School Base | |
|
161 W Victoria St Suite 255 Long Beach CA 90805-2175 | |
| (323) 242-5000 | |
| (323) 242-5011 |
| Full Name | Shields For Families School Base |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 161 W Victoria St, Long Beach, California |
| Authorized Official Name and Position | Kathryn S Icenhower (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 3232425000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shields For Families School Base 11601 S Western Ave Los Angeles CA 90047-5006 Ph: (323) 242-5000 | Shields For Families School Base 161 W Victoria St Suite 255 Long Beach CA 90805-2175 Ph: (323) 242-5000 |
| NPI Number | 1386776110 |
|---|---|
| Provider Enumeration Date | 03/09/2007 |
| Last Update Date | 04/10/2020 |
| Certification Date | 04/10/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386776110 | NPI | - | NPPES |
| 7536 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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