Healthcare Provider Details

I. General information

NPI: 1265306575
Provider Name (Legal Business Name): SAR SHALOM HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 PARK HEIGHTS AVENUE
BALTIMORE MD
21215
US

IV. Provider business mailing address

3601 GREENWAY STE 110
BALTIMORE MD
21218-2438
US

V. Phone/Fax

Practice location:
  • Phone: 443-803-5582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHANA POUPKO
Title or Position: BEHAVIORAL ANALYST
Credential: BCBA
Phone: 443-803-5582