Provider Demographics
NPI:1093320087
Name:H-SHALOM HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:H-SHALOM HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:HAILEMARIAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-332-2971
Mailing Address - Street 1:2821 S PARKER RD STE 1235
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2713
Mailing Address - Country:US
Mailing Address - Phone:303-332-2971
Mailing Address - Fax:
Practice Address - Street 1:2821 S PARKER RD STE 1235
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2713
Practice Address - Country:US
Practice Address - Phone:303-332-2971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO067586Medicaid