Provider Demographics
NPI:1194063875
Name:SHALOM CENTER, INC.
Entity type:Organization
Organization Name:SHALOM CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-399-0520
Mailing Address - Street 1:13516 MORGAN DR
Mailing Address - Street 2:
Mailing Address - City:SPLENDORA
Mailing Address - State:TX
Mailing Address - Zip Code:77372-3121
Mailing Address - Country:US
Mailing Address - Phone:281-399-0520
Mailing Address - Fax:281-399-3366
Practice Address - Street 1:13516 MORGAN DR
Practice Address - Street 2:
Practice Address - City:SPLENDORA
Practice Address - State:TX
Practice Address - Zip Code:77372-3121
Practice Address - Country:US
Practice Address - Phone:281-399-0520
Practice Address - Fax:281-399-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness