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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)

Other Identifiers

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

General Provider Information

NPI Number : 1992924633
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHALOM HEALTH CARE CENTER, INC.
Provider Business Mailing Address
First Line : 3400 LAFAYETTE ROAD
Second Line : SUITE 200
City : INDIANAPOLIS
State : IN
Zip : 46222-1147
Country : US
Telephone Number : 317-291-7422
Fax Number : 317-291-7433
Provider Business Practice Location Address
First Line : 3400 LAFAYETTE ROAD
Second Line : SUITE 200
City : INDIANAPOLIS
State : IN
Zip : 46222-1147
Country : US
Telephone Number : 317-291-7422
Fax Number : 317-291-7433
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : LEONARDO R ORTEGA
Credential : M.D., M.P.H.
Telephone Number : 317-291-7422
Provider Enumeration Date : 04/24/2007
Last Update Date : 01/22/2021

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1740520600 — NICOLE COOK
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1588081293 — MRS. JULIE K KORTH CPNP
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1962803684 — BRETT PARSONS PEARLMAN PNP
Practice Location Address:
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Directions to “SHALOM HEALTH CARE CENTER, INC. ” Practice Location

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