Healthcare Provider Details

I. General information

NPI: 1043159841
Provider Name (Legal Business Name): SHALOM HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 WYNDMOOR AVE
HILLSIDE NJ
07205-1408
US

IV. Provider business mailing address

1550 WYNDMOOR AVE
HILLSIDE NJ
07205-1408
US

V. Phone/Fax

Practice location:
  • Phone: 862-216-1786
  • Fax:
Mailing address:
  • Phone: 862-216-1786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. GABRIEL T EZEORAKWE
Title or Position: PRESIDENT
Credential:
Phone: 862-216-1786