Provider Demographics
NPI:1083324404
Name:SHALOM HEALTH CARE MANAGEMENT LLC
Entity Type:Organization
Organization Name:SHALOM HEALTH CARE MANAGEMENT LLC
Other - Org Name:REVIVE RECOVERY CENTER OF BEAUMONT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NABIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-705-3490
Mailing Address - Street 1:1500 S DAIRY ASHFORD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-3858
Mailing Address - Country:US
Mailing Address - Phone:409-402-0169
Mailing Address - Fax:
Practice Address - Street 1:950 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705-2251
Practice Address - Country:US
Practice Address - Phone:409-402-0169
Practice Address - Fax:409-600-2869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder