Provider Demographics
NPI:1265306575
Name:SAR SHALOM HOLDINGS LLC
Entity type:Organization
Organization Name:SAR SHALOM HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:CHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:POUPKO
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:443-803-5582
Mailing Address - Street 1:3601 GREENWAY STE 110
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2438
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6300 PARK HEIGHTS AVENUE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215
Practice Address - Country:US
Practice Address - Phone:443-803-5582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty