Provider Demographics
NPI:1235021791
Name:SHALOM ENRICHMENT CENTER LLC
Entity type:Organization
Organization Name:SHALOM ENRICHMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:GUMA
Authorized Official - Last Name:MUGENYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-946-0088
Mailing Address - Street 1:12445 W KALER DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85307-1782
Mailing Address - Country:US
Mailing Address - Phone:443-946-0088
Mailing Address - Fax:
Practice Address - Street 1:12445 W KALER DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85307-1782
Practice Address - Country:US
Practice Address - Phone:443-946-0088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health