Provider Demographics
NPI:1205663671
Name:SHALOM WELLNESS CENTER CORP.
Entity type:Organization
Organization Name:SHALOM WELLNESS CENTER CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:JIMENEZ PULIDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-651-4190
Mailing Address - Street 1:4995 NW 72ND AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5643
Mailing Address - Country:US
Mailing Address - Phone:786-651-4190
Mailing Address - Fax:
Practice Address - Street 1:4995 NW 72ND AVE STE 209
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166-5643
Practice Address - Country:US
Practice Address - Phone:786-651-4190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty