Provider Demographics
NPI:1255853602
Name:SHALOM HOMECARE PROVIDERS, LLC
Entity Type:Organization
Organization Name:SHALOM HOMECARE PROVIDERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEMAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:YANCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-250-5040
Mailing Address - Street 1:423 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-2828
Mailing Address - Country:US
Mailing Address - Phone:484-540-7766
Mailing Address - Fax:
Practice Address - Street 1:423 WALNUT ST
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-2828
Practice Address - Country:US
Practice Address - Phone:484-540-7766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-07
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care