Provider Demographics
NPI:1194422402
Name:SHALOM RECOVERY CENTERS
Entity type:Organization
Organization Name:SHALOM RECOVERY CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:COKER
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:501-781-0639
Mailing Address - Street 1:2446 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-9615
Mailing Address - Country:US
Mailing Address - Phone:501-781-0639
Mailing Address - Fax:
Practice Address - Street 1:2446 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-9615
Practice Address - Country:US
Practice Address - Phone:501-781-0639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health