MEDICARE: SHALOM HOME CARE SERVICES, 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	251C00000X	Developmentally Disabled Services Day Training Agency	SIL 6900	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134348337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHALOM HOME CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	3501 HOLIDAY DR
Second Line	:	SUITE 312
City	:	NEW ORLEANS
State	:	LA
Zip	:	70114-8202
Country	:	US
Telephone Number	:	504-365-0233
Fax Number	:	504-365-9954

Provider Business Practice Location Address
First Line	:	3501 HOLIDAY DR
Second Line	:	SUITE 312
City	:	NEW ORLEANS
State	:	LA
Zip	:	70114-8202
Country	:	US
Telephone Number	:	504-365-0233
Fax Number	:	504-365-9954

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	LISA THOMAS
Credential	:
Telephone Number	:	504-365-0233

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	08/22/2020

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