Provider Demographics
NPI:1720496409
Name:SHALOM COKER 24 HOURS SPECIAL NEEDS DAYCARE
Entity Type:Organization
Organization Name:SHALOM COKER 24 HOURS SPECIAL NEEDS DAYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHALOM
Authorized Official - Middle Name:
Authorized Official - Last Name:OSUNDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-374-6955
Mailing Address - Street 1:3103 GREGORY LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-5742
Mailing Address - Country:US
Mailing Address - Phone:972-374-6955
Mailing Address - Fax:
Practice Address - Street 1:3103 GREGORY LN
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-5742
Practice Address - Country:US
Practice Address - Phone:972-374-6955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLVN#221824315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities