MEDICARE: SHALOM ENTERPRISE

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1861340143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHALOM ENTERPRISE

Provider Business Mailing Address
First Line	:	18473 W IVY LN
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85388-2349
Country	:	US
Telephone Number	:	623-920-1737
Fax Number	:

Provider Business Practice Location Address
First Line	:	3768 BEAR DR
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86406-4377
Country	:	US
Telephone Number	:	928-302-1671
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. RITA BYRON
Credential	:
Telephone Number	:	928-302-1527

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	05/19/2026

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Directions to “SHALOM ENTERPRISE ” Practice Location

Language	Start Address	Practice Location

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