Healthcare Provider Details

I. General information

NPI: 1124536792
Provider Name (Legal Business Name): SHALOM HOMES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 01/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 BROOKHAVEN LN
UPPER MARLBORO MD
20772-6658
US

IV. Provider business mailing address

10400 BROOKHAVEN LN
UPPER MARLBORO MD
20772-6658
US

V. Phone/Fax

Practice location:
  • Phone: 301-543-0741
  • Fax:
Mailing address:
  • Phone: 301-543-0741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. JESTINA SAYON JALLOH-JAMBORIA
Title or Position: CEO/DON
Credential: CRNP
Phone: 301-543-0741