MEDICARE: SHALOM INTERNATIONAL

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1679429757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHALOM INTERNATIONAL

Provider Business Mailing Address
First Line	:	5572 AUDUBON RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48224-2663
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5572 AUDUBON RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48224-2663
Country	:	US
Telephone Number	:	313-399-1967
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CHRISTOPHER RATCLIFF
Credential	:
Telephone Number	:	313-399-1967

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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Directions to “SHALOM INTERNATIONAL ” Practice Location

Language	Start Address	Practice Location

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