Provider Demographics
NPI:1083064158
Name:SHALOM HOMECARE LLC
Entity type:Organization
Organization Name:SHALOM HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-572-1069
Mailing Address - Street 1:127 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-1805
Mailing Address - Country:US
Mailing Address - Phone:267-642-2645
Mailing Address - Fax:267-382-1907
Practice Address - Street 1:126 PENN AVE
Practice Address - Street 2:
Practice Address - City:TELFORD
Practice Address - State:PA
Practice Address - Zip Code:18969-1977
Practice Address - Country:US
Practice Address - Phone:215-572-1069
Practice Address - Fax:267-382-1907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA31083601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care