Provider Demographics
NPI:1033877030
Name:SHALOM HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:SHALOM HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:O
Authorized Official - Last Name:ASIELIUE
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:773-876-4837
Mailing Address - Street 1:3601 W DEVON AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1299
Mailing Address - Country:US
Mailing Address - Phone:773-961-7210
Mailing Address - Fax:773-943-6355
Practice Address - Street 1:8723 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-3103
Practice Address - Country:US
Practice Address - Phone:773-876-4837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3001492Medicaid