=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609901032
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHALOM INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2007
-----------------------------------------------------
Last Update Date | 03/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1080 N DELAWARE AVE SUITE 602
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19125-4330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-425-7727
-----------------------------------------------------
Fax | 215-425-7785
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1080 N DELAWARE AVE SUITE 602
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19125-4330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-425-7727
-----------------------------------------------------
Fax | 215-425-7785
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EX. DIRECTOR
-----------------------------------------------------
Name | MADELEINE BOYD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-425-7727
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------