Provider Demographics
NPI:1710644240
Name:SHALOM NURSING CARE LLC
Entity Type:Organization
Organization Name:SHALOM NURSING CARE LLC
Other - Org Name:SHALOM NURSING CARE INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-957-5824
Mailing Address - Street 1:6475 NEW HAMPSHIRE AVE STE 350F
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3282
Mailing Address - Country:US
Mailing Address - Phone:301-957-5824
Mailing Address - Fax:240-468-7255
Practice Address - Street 1:6475 NEW HAMPSHIRE AVE STE 350F
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3282
Practice Address - Country:US
Practice Address - Phone:301-957-5824
Practice Address - Fax:240-468-7255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-18
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5893006600Medicaid