Healthcare Provider Details

I. General information

NPI: 1023756285
Provider Name (Legal Business Name): SHALOM HOSPICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5409 MARYLAND WAY STE 212
BRENTWOOD TN
37027-5068
US

IV. Provider business mailing address

5409 MARYLAND WAY STE 212
BRENTWOOD TN
37027-5068
US

V. Phone/Fax

Practice location:
  • Phone: 510-499-9977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL STERN
Title or Position: CEO
Credential:
Phone: 510-499-9977