Provider Demographics
NPI:1124536792
Name:SHALOM HOMES, INC
Entity Type:Organization
Organization Name:SHALOM HOMES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESTINA
Authorized Official - Middle Name:SAYON
Authorized Official - Last Name:JALLOH-JAMBORIA
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:301-543-0741
Mailing Address - Street 1:10400 BROOKHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6658
Mailing Address - Country:US
Mailing Address - Phone:301-543-0741
Mailing Address - Fax:
Practice Address - Street 1:10400 BROOKHAVEN LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-6658
Practice Address - Country:US
Practice Address - Phone:301-543-0741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty