Provider Demographics
NPI:1841794724
Name:SHALOM COMMUNITY CARE INC
Entity type:Organization
Organization Name:SHALOM COMMUNITY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:POBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-499-2712
Mailing Address - Street 1:2201 MURFREESBORO PIKE STE A222
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-3463
Mailing Address - Country:US
Mailing Address - Phone:615-678-5041
Mailing Address - Fax:615-457-1193
Practice Address - Street 1:2201 MURFREESBORO PIKE STE A222
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-3463
Practice Address - Country:US
Practice Address - Phone:615-678-5041
Practice Address - Fax:615-457-1193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN100000016879253Z00000X, 385HR2060X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No253Z00000XAgenciesIn Home Supportive Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child