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General NPI Number Information
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NPI Number | 1780977678
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Entity Type | Organization
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Legal Business Name | SHALOM PRENATAL & BIRTHING SERVICES LLC
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Dates
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Enumeration Date | 05/25/2011
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 5595 SW EVANNA DR
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City | MOUNTAIN HOME
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State | ID
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Zip | 83647-6401
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Country | US
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Telephone | 208-599-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 5595 SW EVANNA DR
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City | MOUNTAIN HOME
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State | ID
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Zip | 83647-6041
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Country | US
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Telephone | 208-599-0300
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Fax |
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Authorized Official
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Title or Position | MIDWIFE
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Name | MRS. KAREN B MASHAK
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Credential | L.M.
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Telephone | 208-599-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QB0400X
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Taxonomy Name | Birthing Clinic/Center
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License Number | MIDGM-31
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License Number State | ID
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