Provider Demographics
NPI:1669863486
Name:SHALOM HOUSE INC #2
Entity Type:Organization
Organization Name:SHALOM HOUSE INC #2
Other - Org Name:SHALOM HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:L
Authorized Official - Last Name:POINDEXTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:404-630-3520
Mailing Address - Street 1:13905 E 39TH ST S STE 104
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-3378
Mailing Address - Country:US
Mailing Address - Phone:816-272-8181
Mailing Address - Fax:660-256-4182
Practice Address - Street 1:13905 E 39TH ST S STE 104
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-3378
Practice Address - Country:US
Practice Address - Phone:816-272-8181
Practice Address - Fax:816-256-4182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based