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General NPI Number Information
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NPI Number | 1861340143
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Entity Type | Organization
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Legal Business Name | SHALOM ENTERPRISE
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Dates
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Enumeration Date | 03/20/2026
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Last Update Date | 03/20/2026
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Provider Practice Location Address
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Address Line | 3768 BEAR DR
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86406-4377
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Country | US
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Telephone | 928-302-1671
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Fax |
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Provider Business Mailing Address
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Address Line | 18473 W IVY LN
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City | SURPRISE
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State | AZ
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Zip | 85388-2349
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Country | US
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Telephone | 623-920-1737
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. RUDY BYRON JR.
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Credential |
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Telephone | 623-920-1737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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