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General NPI Number Information
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NPI Number | 1750093050
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Entity Type | Organization
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Legal Business Name | SHALOM HERITAGE, LLC
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Dates
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Enumeration Date | 12/19/2022
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 6748 S DENNIS DR
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City | TEMPE
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State | AZ
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Zip | 85283-5426
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Country | US
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Telephone | 480-845-9165
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Fax |
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Provider Business Mailing Address
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Address Line | 6748 S DENNIS DR
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City | TEMPE
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State | AZ
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Zip | 85283-5426
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Country | US
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Telephone | 480-845-9165
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | DAVID ADEBAYO OGUNTOLA
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Credential |
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Telephone | 480-845-9165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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