Provider Demographics
NPI:1457304453
Name:SHALEM HOME HEALTH CARE,INC
Entity Type:Organization
Organization Name:SHALEM HOME HEALTH CARE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERIL
Authorized Official - Middle Name:MEGAN
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:972-290-4994
Mailing Address - Street 1:2611 N BELT LINE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-9357
Mailing Address - Country:US
Mailing Address - Phone:972-290-4994
Mailing Address - Fax:972-285-8561
Practice Address - Street 1:2611 N BELT LINE RD STE 101
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-9357
Practice Address - Country:US
Practice Address - Phone:972-290-4994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX457984251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457984Medicare Oscar/Certification