Healthcare Provider Details

I. General information

NPI: 1699690545
Provider Name (Legal Business Name): SHALOM HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 LAMAR AVENUE
PUEBLO CO
81004-2389
US

IV. Provider business mailing address

P.O. BOX 274
PARKER CO
80134-8998
US

V. Phone/Fax

Practice location:
  • Phone: 719-542-2715
  • Fax: 719-543-6358
Mailing address:
  • Phone: 720-635-4734
  • Fax: 720-420-1322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: MELANY S WONG
Title or Position: ADMINISTRATOR
Credential:
Phone: 720-635-4734