Provider Demographics
NPI:1427864263
Name:SHALOM HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:SHALOM HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:ADETAYO
Authorized Official - Last Name:ADETONA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:608-206-5318
Mailing Address - Street 1:4232 W 124TH STREET
Mailing Address - Street 2:TOWNHOUSE
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4232 W 124TH STREET
Practice Address - Street 2:TOWNHOUSE
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378
Practice Address - Country:US
Practice Address - Phone:608-206-5318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health