Healthcare Provider Details

I. General information

NPI: 1518725613
Provider Name (Legal Business Name): SHALOM HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6346 W CATALINA DR
PHOENIX AZ
85033-5712
US

IV. Provider business mailing address

6346 W CATALINA DR
PHOENIX AZ
85033-5712
US

V. Phone/Fax

Practice location:
  • Phone: 240-559-7617
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: SCOVIA BASALIZA
Title or Position: OWNER
Credential:
Phone: 240-559-7617