Provider Demographics
NPI:1720775455
Name:SHALOM SPRINGS ADULT FAMILY HOME INC.
Entity type:Organization
Organization Name:SHALOM SPRINGS ADULT FAMILY HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:DICKSON
Authorized Official - Middle Name:KIMANDI
Authorized Official - Last Name:MWIRABUA
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:678-431-8085
Mailing Address - Street 1:909 138TH ST E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98445-2778
Mailing Address - Country:US
Mailing Address - Phone:678-431-8085
Mailing Address - Fax:
Practice Address - Street 1:909 138TH ST E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98445-2778
Practice Address - Country:US
Practice Address - Phone:678-431-8085
Practice Address - Fax:253-267-1453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care