Provider Demographics
NPI:1518725613
Name:SHALOM HOME CARE LLC
Entity Type:Organization
Organization Name:SHALOM HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASALIZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-559-7617
Mailing Address - Street 1:6346 W CATALINA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-5712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6346 W CATALINA DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-5712
Practice Address - Country:US
Practice Address - Phone:240-559-7617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitationGroup - Multi-Specialty