Provider Demographics
NPI:1922727148
Name:SHALOM RUN NON EMERGENCY MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:SHALOM RUN NON EMERGENCY MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NDIKUMANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-724-9905
Mailing Address - Street 1:1212 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52802-1369
Mailing Address - Country:US
Mailing Address - Phone:773-724-9905
Mailing Address - Fax:
Practice Address - Street 1:1212 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52802-1369
Practice Address - Country:US
Practice Address - Phone:773-724-9905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)