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General NPI Number Information
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NPI Number | 1629907860
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Entity Type | Organization
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Legal Business Name | SHALOM HOUSE LLC
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Dates
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Enumeration Date | 05/14/2026
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Last Update Date | 05/14/2026
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Provider Practice Location Address
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Address Line | 975 LEKEONA LOOP
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City | WAILUKU
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State | HI
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Zip | 96793-9656
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Country | US
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Telephone | 714-331-5949
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Fax | 808-214-5747
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Provider Business Mailing Address
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Address Line | 975 LEKEONA LOOP
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City | WAILUKU
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State | HI
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Zip | 96793-9656
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Country | US
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Telephone | 714-331-5949
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Fax | 808-214-5747
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Authorized Official
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Title or Position | OWNER
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Name | MILA CORTEZ GOROSPE
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Credential | CCFFH
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Telephone | 714-331-5949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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