Provider Demographics
NPI:1356094551
Name:SHALOM DESTINY NURSING CONSULTANT AND TRAINING SERVICES LLC
Entity Type:Organization
Organization Name:SHALOM DESTINY NURSING CONSULTANT AND TRAINING SERVICES LLC
Other - Org Name:SHALOM DESTINY DIAGNOSTIC LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:434-944-8511
Mailing Address - Street 1:221 VANDOLA CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-7465
Mailing Address - Country:US
Mailing Address - Phone:434-944-8511
Mailing Address - Fax:
Practice Address - Street 1:221 VANDOLA CHURCH RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-7465
Practice Address - Country:US
Practice Address - Phone:434-944-8511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHALOM DESTINY NURSING CONSULTANT AND TRAINING SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-28
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center