Provider Demographics
NPI:1689215766
Name:SHALUMSTAR HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:SHALUMSTAR HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FLORE
Authorized Official - Middle Name:LELY
Authorized Official - Last Name:MOUANG
Authorized Official - Suffix:
Authorized Official - Credentials:PATIENT CARE TECH
Authorized Official - Phone:202-790-3932
Mailing Address - Street 1:11360 EVANS TRL APT T4
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3031
Mailing Address - Country:US
Mailing Address - Phone:202-790-3932
Mailing Address - Fax:
Practice Address - Street 1:11360 EVANS TRL APT T4
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3031
Practice Address - Country:US
Practice Address - Phone:202-790-3932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty