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General NPI Number Information
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NPI Number | 1720650583
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Entity Type | Organization
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Legal Business Name | SHALOM BEHAVIORAL CARE LLC
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Dates
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Enumeration Date | 07/12/2021
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Last Update Date | 07/12/2021
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Provider Practice Location Address
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Address Line | 10612 E MARIGOLD LN
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City | FLORENCE
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State | AZ
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Zip | 85132-7320
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Country | US
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Telephone | 480-684-2004
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Fax | 480-582-6043
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Provider Business Mailing Address
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Address Line | 10612 E MARIGOLD LN
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City | FLORENCE
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State | AZ
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Zip | 85132-7320
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Country | US
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Telephone | 480-684-2004
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Fax |
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Authorized Official
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Title or Position | STATUTORY OFFICER
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Name | ANTHONY VINCENT OLORUNSOLA
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Credential |
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Telephone | 623-806-6864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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