Provider Demographics
NPI:1457663635
Name:SHALOM LIVING CENTER
Entity Type:Organization
Organization Name:SHALOM LIVING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATILDA
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-832-0337
Mailing Address - Street 1:1810 EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77705-1815
Mailing Address - Country:US
Mailing Address - Phone:409-832-0337
Mailing Address - Fax:
Practice Address - Street 1:1810 EUCLID ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705-1815
Practice Address - Country:US
Practice Address - Phone:409-832-0337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-05
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization