Provider Demographics
NPI:1841736469
Name:TAF SHALOM HEALTHCARE SERVICES, INC
Entity Type:Organization
Organization Name:TAF SHALOM HEALTHCARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLUFUNKE
Authorized Official - Middle Name:ADEBISI
Authorized Official - Last Name:ODUKOYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-925-9448
Mailing Address - Street 1:14810 CICERO AVE
Mailing Address - Street 2:UNIT 2W
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-1400
Mailing Address - Country:US
Mailing Address - Phone:708-925-9448
Mailing Address - Fax:708-925-9448
Practice Address - Street 1:14810 CICERO AVE
Practice Address - Street 2:UNIT 2W
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-1400
Practice Address - Country:US
Practice Address - Phone:708-925-9448
Practice Address - Fax:708-925-9448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-07
Last Update Date:2017-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL4000538251J00000X
IL3001437253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care