Provider Demographics
NPI:1992924633
Name:SHALOM HEALTH CARE CENTER, INC.
Entity type:Organization
Organization Name:SHALOM HEALTH CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:R
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:317-291-7422
Mailing Address - Street 1:3400 LAFAYETTE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-1147
Mailing Address - Country:US
Mailing Address - Phone:317-291-7422
Mailing Address - Fax:317-291-7433
Practice Address - Street 1:3400 LAFAYETTE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1147
Practice Address - Country:US
Practice Address - Phone:317-291-7422
Practice Address - Fax:317-291-7433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200392480Medicaid
IN151832Medicare Oscar/Certification
IN151831Medicare Oscar/Certification
IN215870Medicare PIN
IN200392480Medicaid
IN151839Medicare Oscar/Certification