1841794724 NPI number — SHALOM COMMUNITY CARE INC

Table of content: (NPI 1841794724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841794724 NPI number — SHALOM COMMUNITY CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHALOM COMMUNITY CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841794724
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2201 MURFREESBORO PIKE STE A222
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37217-3463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-678-5041
Provider Business Mailing Address Fax Number:
615-457-1193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2201 MURFREESBORO PIKE STE A222
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37217-3463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-678-5041
Provider Business Practice Location Address Fax Number:
615-457-1193
Provider Enumeration Date:
03/23/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
POBI
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
615-499-2712

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  100000016879 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X , with the licence number: 100000016879 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 385HR2060X , with the licence number: 100000016879 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)