Provider Demographics
NPI:1760922918
Name:SHALOM NURSING CARE INC
Entity Type:Organization
Organization Name:SHALOM NURSING CARE INC
Other - Org Name:SHALOM NURSING CARE, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESTINA
Authorized Official - Middle Name:SAYON
Authorized Official - Last Name:JALLOH-JAMBORIA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:301-543-0741
Mailing Address - Street 1:10400 BROOKHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6658
Mailing Address - Country:US
Mailing Address - Phone:301-543-0741
Mailing Address - Fax:
Practice Address - Street 1:10400 BROOKHAVEN LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-6658
Practice Address - Country:US
Practice Address - Phone:301-543-0741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WH0200X, 363LA2200X, 363LC1500X, 363LF0000X, 374U00000X
MDR203541251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5893006600Medicaid