| Shields For Families Mst | |
|
121 W Victoria St Long Beach CA 90805-2162 | |
| (310) 603-4030 | |
| (310) 603-1377 |
| Full Name | Shields For Families Mst |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 121 W Victoria St, Long Beach, California |
| Authorized Official Name and Position | Kathryn 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 Mst 11601 S Western Ave Los Angeles CA 90047-5006 Ph: () - | Shields For Families Mst 121 W Victoria St Long Beach CA 90805-2162 Ph: (310) 603-4030 |
| NPI Number | 1235330903 |
|---|---|
| Provider Enumeration Date | 05/30/2007 |
| Last Update Date | 12/21/2020 |
| Certification Date | 12/21/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235330903 | NPI | - | NPPES |
| 7465 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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