Provider Demographics
NPI:1679700074
Name:J.SHALOM CHOICE OF LIVING, ENTERPRISES
Entity Type:Organization
Organization Name:J.SHALOM CHOICE OF LIVING, ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIE-REGINALD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-308-9978
Mailing Address - Street 1:1845 NE 169TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3024
Mailing Address - Country:US
Mailing Address - Phone:786-308-9978
Mailing Address - Fax:305-947-4106
Practice Address - Street 1:1845 NE 169TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3024
Practice Address - Country:US
Practice Address - Phone:786-308-9978
Practice Address - Fax:305-947-4106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL691821296251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========Medicaid