Provider Demographics
NPI:1396411146
Name:SHALAH HOME HEALTH AGENCY INC
Entity Type:Organization
Organization Name:SHALAH HOME HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISMAEL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LOPEZ REINOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-875-5193
Mailing Address - Street 1:1140 6TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4021
Mailing Address - Country:US
Mailing Address - Phone:863-875-5193
Mailing Address - Fax:863-280-0342
Practice Address - Street 1:1140 6TH ST NW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4021
Practice Address - Country:US
Practice Address - Phone:863-875-5193
Practice Address - Fax:863-280-0342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health