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General NPI Number Information
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NPI Number | 1134515547
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Entity Type | Organization
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Legal Business Name | SHALOM FAMILY CARE
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Dates
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Enumeration Date | 04/13/2015
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Last Update Date | 04/13/2015
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Provider Practice Location Address
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Address Line | 35106 WIND WALKER EST
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City | PRAIRIE DU CHIEN
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State | WI
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Zip | 53821-8078
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Country | US
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Telephone | 608-412-1418
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Fax |
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Provider Business Mailing Address
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Address Line | 35106 WIND WALKER EST
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City | PRAIRIE DU CHIEN
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State | WI
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Zip | 53821-8078
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Country | US
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Telephone | 608-412-1418
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Fax | 608-729-4321
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | TIMOTHY J CUMMUTA
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Credential |
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Telephone | 608-412-1418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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