1114105657 NPI number — SHALOM HEALTH CARE SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114105657 NPI number — SHALOM HEALTH CARE SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHALOM HEALTH CARE SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114105657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13018 ALPENHORN WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20904-7311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-890-5972
Provider Business Mailing Address Fax Number:
301-890-5180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13018 ALPENHORN WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20904-7311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-890-5972
Provider Business Practice Location Address Fax Number:
301-890-5180
Provider Enumeration Date:
02/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
OKORIE
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
DIMGBA
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
301-588-7506

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X , with the licence number:  R2521 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: R2521 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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