Provider Demographics
NPI:1528933371
Name:SHALOM HERITAGE LLC- HOPE HOME
Entity type:Organization
Organization Name:SHALOM HERITAGE LLC- HOPE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNTOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-989-7334
Mailing Address - Street 1:2010 E DIAMOND DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3316
Mailing Address - Country:US
Mailing Address - Phone:602-989-7334
Mailing Address - Fax:
Practice Address - Street 1:8537 E NATAL CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-6769
Practice Address - Country:US
Practice Address - Phone:602-989-7334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHALOM HERITAGE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities