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NPI Code Detail

MEDICARE: SHALOM HEALTH CARE CENTER, INC.

MEDICARE: SHALOM HEALTH CARE CENTER, INC.
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
1261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1538167036
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHALOM HEALTH CARE CENTER, INC.
Provider Business Mailing Address
First Line : 3400 LAFAYETTE RD
Second Line : SUTIE 200
City : INDIANAPOLIS
State : IN
Zip : 46222-1146
Country : US
Telephone Number : 317-291-7422
Fax Number : 317-291-7433
Provider Business Practice Location Address
First Line : 3400 LAFAYETTE RD
Second Line : SUTIE 200
City : INDIANAPOLIS
State : IN
Zip : 46222-1146
Country : US
Telephone Number : 317-291-7422
Fax Number : 317-291-7433
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. LEONARDO R ORTEGA
Credential : MD, MPH
Telephone Number : 317-291-7422
Provider Enumeration Date : 07/08/2005
Last Update Date : 01/22/2021

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Directions to “SHALOM HEALTH CARE CENTER, INC. ” Practice Location

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