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SHIRLEY'S ICF DD N NO 5
NPI 1053563536
Nursing Facility/Intermediate Care Facility in Stockton, CA

Active since October 16, 2008CLIA Certified · 2 labs
9565 COLINGTON PL, STOCKTON, CA 95209(209) 952-6027(209) 952-7829 Get Directions Write a Review

NPPES record last updated: October 16, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shirley's Icf Dd N No 5 NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHIRLEY'S ICF DD N NO 5 (NPI 1053563536) is a healthcare organization registered as a nursing facility/intermediate care facility in Stockton, California and active in the NPI registry since October 2008. The organization holds 2 active CLIA laboratory certificates and lists Shirley E Gapasin, Chief Financial Officer, as its authorized official.

NPPES Registry Identity

NPI1053563536
Entity TypeOrganization
Primary Taxonomy313M00000X
Legal Business NameSHIRLEY'S ICF DD N NO 5
Location Address9565 COLINGTON PLStockton, CA 95209-5013
Mailing Address1182 Duvall CtStockton, CA 95210-3581 · (209) 475-9829 · Fax (209) 475-9845
Phone(209) 952-6027
Fax(209) 952-7829
Organization SubpartYesParent: Shirley's Care Home Inc
Authorized OfficialShirley E GapasinChief Financial Officer · (209) 607-9380
Enumeration DateOctober 16, 2008
✔ NPI 1053563536 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNursing Facility/Intermediate Care FacilityNursing & Custodial Care Facilities
Taxonomy Code313M00000X
License✔ Licensed in CA · 5500000686
Definition
An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.
9565 COLINGTON PL, Stockton, CA 95209
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Other Identifiers 3

Medicare OSCAR/certification55G247CA
Medicare OSCAR/certification05G976CA
Medicare OSCAR/certification55G389

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D1086638

Shirley's 1cf Ddn #5 · Stockton, CA
Active · expires Jul 15, 2028
CLIA Number05D1086638
Laboratory TypeIntermediate Care Facility For Mentally Retarded
Certificate Effective DateJuly 16, 2026
Certificate Expiration DateJuly 15, 2028
Laboratory DirectorRaghunath Reddy MD
Laboratory Phone(209) 475-9829
Laboratory LocationShirley's 1cf Ddn #51182 Duvall Ct, Stockton, CA 95210
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 05D0930003

Shirley's Icf Dd-N · Stockton, CA
Active · expires Jun 25, 2027
CLIA Number05D0930003
Laboratory TypeIntermediate Care Facility For Mentally Retarded
Certificate Effective DateJune 26, 2025
Certificate Expiration DateJune 25, 2027
Laboratory DirectorRaghunath Reddy, MD
Laboratory Phone(209) 951-7225
Laboratory LocationShirley's Icf Dd-N2812 Appling Circle, Stockton, CA 95209
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SHIRLEY'S CARE HOME INC
Intermediate Care Facility, Intellectual Disabilities
9565 COLINGTON PL
STOCKTON, CA 95209
San Joaquin County (209) 952-6027
SHIRLEY'S CARE HOME
Nursing Facility/Intermediate Care Facility
9565 COLINGTON PL
STOCKTON, CA 95209
San Joaquin County (209) 607-9380

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shirley's Icf Dd N No 5's NPI number?

The NPI number for Shirley's Icf Dd N No 5 is 1053563536. It was assigned to this organization in the NPPES registry on October 16, 2008.

Where is Shirley's Icf Dd N No 5 located?

Shirley's Icf Dd N No 5 is located at 9565 Colington Pl, Stockton, CA 95209. The listed phone number is (209) 952-6027.

What is Shirley's Icf Dd N No 5's specialty?

The primary specialty registered for this NPI is Nursing Facility/Intermediate Care Facility with taxonomy code 313M00000X.

Does Shirley's Icf Dd N No 5 hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Shirley's Icf Dd N No 5 was last updated on October 16, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.