MEDICARE: EL-SHALOM 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
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1255290441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL-SHALOM LLC

Provider Business Mailing Address
First Line	:	27323 E EUCLID DR
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80016-2507
Country	:	US
Telephone Number	:	303-523-0810
Fax Number	:

Provider Business Practice Location Address
First Line	:	27323 E EUCLID DR
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80016-2507
Country	:	US
Telephone Number	:	303-523-0810
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	ACHAMYELESH WAGAYE
Credential	:
Telephone Number	:	303-523-0810

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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