Provider Demographics
NPI:1134515547
Name:SHALOM FAMILY CARE
Entity Type:Organization
Organization Name:SHALOM FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CUMMUTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-412-1418
Mailing Address - Street 1:35106 WIND WALKER EST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU CHIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53821-8078
Mailing Address - Country:US
Mailing Address - Phone:608-412-1418
Mailing Address - Fax:608-729-4321
Practice Address - Street 1:35106 WIND WALKER EST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821-8078
Practice Address - Country:US
Practice Address - Phone:608-412-1418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health