Provider Demographics
NPI:1609901032
Name:SHALOM INC.
Entity Type:Organization
Organization Name:SHALOM INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EX. DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MADELEINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-425-7727
Mailing Address - Street 1:1080 N DELAWARE AVE
Mailing Address - Street 2:SUITE 602
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-4330
Mailing Address - Country:US
Mailing Address - Phone:215-425-7727
Mailing Address - Fax:215-425-7785
Practice Address - Street 1:1080 N DELAWARE AVE
Practice Address - Street 2:SUITE 602
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-4330
Practice Address - Country:US
Practice Address - Phone:215-425-7727
Practice Address - Fax:215-425-7785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA119070OtherCBH DA OUTPATIENT
PA81093OtherCBH MH OUTPATIENT