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General NPI Number Information
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NPI Number | 1518885136
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Entity Type | Organization
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Legal Business Name | SHALOM BEHAVIORAL WELLNESS CENTER LLC.
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Dates
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Enumeration Date | 07/09/2026
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Last Update Date | 07/09/2026
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Provider Practice Location Address
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Address Line | 1500 COLONIAL BLVD STE 102
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City | FORT MYERS
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State | FL
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Zip | 33907-1025
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Country | US
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Telephone | 786-296-5701
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 COLONIAL BLVD STE 102
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City | FORT MYERS
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State | FL
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Zip | 33907-1025
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Country | US
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Telephone | 786-296-5701
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | YULEYSI ALVAREZ GANDARA
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Credential |
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Telephone | 786-296-5701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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