Provider Demographics
NPI:1689792178
Name:SHALOM FAMILY INC.
Entity Type:Organization
Organization Name:SHALOM FAMILY INC.
Other - Org Name:SHALOM MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER - PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-340-3898
Mailing Address - Street 1:15057 EAST COLFAX AVE.
Mailing Address - Street 2:UNIT C
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-5776
Mailing Address - Country:US
Mailing Address - Phone:303-340-3898
Mailing Address - Fax:303-364-1361
Practice Address - Street 1:15057 EAST COLFAX AVE.
Practice Address - Street 2:UNIT C
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-5776
Practice Address - Country:US
Practice Address - Phone:303-340-3898
Practice Address - Fax:303-364-1361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41-63222-0000332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO99539039Medicaid
CO99539039Medicaid