MEDICARE: SHALOM HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1043159841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHALOM HOME CARE LLC

Provider Business Mailing Address
First Line	:	1550 WYNDMOOR AVE
Second Line	:
City	:	HILLSIDE
State	:	NJ
Zip	:	07205-1408
Country	:	US
Telephone Number	:	862-216-1786
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 WYNDMOOR AVE
Second Line	:
City	:	HILLSIDE
State	:	NJ
Zip	:	07205-1408
Country	:	US
Telephone Number	:	862-216-1786
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GABRIEL T EZEORAKWE
Credential	:
Telephone Number	:	862-216-1786

Provider Enumeration Date	:	03/26/2026
Last Update Date	:	03/26/2026

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