Provider Demographics
NPI:1306400502
Name:SHALOM CARES WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:SHALOM CARES WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:PENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-680-5000
Mailing Address - Street 1:14800 E BELLEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-2258
Mailing Address - Country:US
Mailing Address - Phone:303-680-5000
Mailing Address - Fax:303-699-6577
Practice Address - Street 1:14800 E BELLEVIEW DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-2258
Practice Address - Country:US
Practice Address - Phone:303-680-5000
Practice Address - Fax:303-699-6577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)