Provider Demographics
NPI:1528471711
Name:SHALOM HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:SHALOM HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGES WILLIAM
Authorized Official - Middle Name:N
Authorized Official - Last Name:NTEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-938-3750
Mailing Address - Street 1:15590 N HIGHWAY 329
Mailing Address - Street 2:
Mailing Address - City:REDDICK
Mailing Address - State:FL
Mailing Address - Zip Code:32686-3053
Mailing Address - Country:US
Mailing Address - Phone:301-938-3750
Mailing Address - Fax:
Practice Address - Street 1:15590 N HIGHWAY 329
Practice Address - Street 2:
Practice Address - City:REDDICK
Practice Address - State:FL
Practice Address - Zip Code:32686-3053
Practice Address - Country:US
Practice Address - Phone:301-938-3750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLR199962251S00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health