Provider Demographics
NPI:1740617125
Name:SHALOM CARE SERVICES,LLC
Entity Type:Organization
Organization Name:SHALOM CARE SERVICES,LLC
Other - Org Name:RELIEF AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEANNOT
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:MAP CERTIFIED
Authorized Official - Phone:617-519-8284
Mailing Address - Street 1:272 BROADWAY UNIT 996
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-8044
Mailing Address - Country:US
Mailing Address - Phone:617-519-8284
Mailing Address - Fax:
Practice Address - Street 1:272 BROADWAY UNIT 996
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-8044
Practice Address - Country:US
Practice Address - Phone:617-519-8284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X, 320600000X
MA38580427000320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No253Z00000XAgenciesIn Home Supportive Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities