Provider Demographics
NPI:1578149019
Name:SHALOM HOMES CARE LLC
Entity Type:Organization
Organization Name:SHALOM HOMES CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:MUHITIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-231-2676
Mailing Address - Street 1:118 PIERCE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7881
Mailing Address - Country:US
Mailing Address - Phone:949-231-2676
Mailing Address - Fax:
Practice Address - Street 1:118 PIERCE ST APT 2
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7881
Practice Address - Country:US
Practice Address - Phone:949-231-2676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No253Z00000XAgenciesIn Home Supportive Care
No310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness