Provider Demographics
NPI:1285480525
Name:SHALOM SELAM TRANSPORTATION LLC
Entity type:Organization
Organization Name:SHALOM SELAM TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SELAMAWIT
Authorized Official - Middle Name:KIDANE
Authorized Official - Last Name:GEBREMARIAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-338-7184
Mailing Address - Street 1:800 W RENNER RD APT 523
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-1033
Mailing Address - Country:US
Mailing Address - Phone:469-335-7184
Mailing Address - Fax:
Practice Address - Street 1:800 W RENNER RD APT 523
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-1033
Practice Address - Country:US
Practice Address - Phone:469-335-7184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-26
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)