Provider Demographics
NPI:1134266281
Name:SHALOM HOME HEALTH, INC.
Entity type:Organization
Organization Name:SHALOM HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OLABISI
Authorized Official - Middle Name:L
Authorized Official - Last Name:BELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-475-4541
Mailing Address - Street 1:2821 N ROXBORO ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-3245
Mailing Address - Country:US
Mailing Address - Phone:919-475-4541
Mailing Address - Fax:919-321-8659
Practice Address - Street 1:2821 N ROXBORO ST
Practice Address - Street 2:UNIT A
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-3245
Practice Address - Country:US
Practice Address - Phone:919-475-4541
Practice Address - Fax:919-321-8659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3618251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418390Medicaid
NC6601670Medicaid