MEDICARE: SHALOM PALACE AFH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility

General Provider Information

NPI Number	:	1396580536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHALOM PALACE AFH LLC

Provider Business Mailing Address
First Line	:	8426 116TH ST SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98498-3608
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8426 116TH ST SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98498-3608
Country	:	US
Telephone Number	:	253-292-8033
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER
Name	:	JOSEPH MURIU
Credential	:
Telephone Number	:	253-292-8033

Provider Enumeration Date	:	06/28/2024
Last Update Date	:	06/28/2024

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Directions to “SHALOM PALACE AFH LLC ” Practice Location

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