SHALOM BEHAVIORAL CARE LLC (NPI# 1619457785) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619457785 |
| Entity Type | Organization |
| Organization Name | SHALOM BEHAVIORAL CARE LLC |
| Practice Address |
35301 N Belgian Blue Ct San Tan Valley AZ 85143 |
| Mailing Address |
35301 N Belgian Blue Ct San Tan Valley AZ 85143-5497 |
| Practice Telephone | 4806870462 |
| Mailing Telephone | 4806870462 |
| Enumeration Date | 2018-08-18 |
| Last Update Date | 2018-08-28 |
| Authorized Official Name | ANTHONY VINCENT OLORUNSOLA (NURSE PRACTITIONER) |
| Authorized Official Telephone | 6238066864 |
| Authorized Official Credential | FNP -BC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | BH5490 | AZ | Residential Treatment Facilities |
| Street Address |
35301 N BELGIAN BLUE CT |
| City | SAN TAN VALLEY |
| State | AZ |
| Zip Code | 85143 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336662337 | House of Dignity Assisted Living LLC | Assisted Living Facility | 214 W Danish Red Trl, San Tan Valley, AZ 85143 | 2017-07-21 |
| 1942744081 | Arizona Dental Professionals, PC | Dentist | 545 E Hunt Hwy, San Tan Valley, AZ 85143 | 2016-12-08 |
| 1285000786 | Jared Scott Snyder | Physical Therapy Assistant | 1745 E Hunt Hwy, Suite 103, San Tan Valley, AZ 85143 | 2015-08-19 |
| 1801289236 | Tiffany Battle | Behavioral Analyst | 2626 E. Manuel Road, San Tan Valley, AZ 85143 | 2015-03-10 |
| 1437541091 | Kelly Denise Griffin | Registered Nurse | 35945 N. Gary Rd, Suite 101, San Tan Valley, AZ 85143 | 2015-02-19 |
| 1528496031 | Casey Manzanedo | Licensed Practical Nurse | 35900 E Charbray Dr., San Tan Valley, AZ 85143 | 2013-10-18 |
| 1891136461 | Lisa Kay Scarpa | Home Health Aide | 925 E Canyon Rock Rd, San Tan Valley, AZ 85143 | 2013-07-11 |
| 1790969426 | Emilia Elizabeth Gomez Vieytez | Pediatrics | 22707 S. Ellsworth Rd H 101, Queen Creek, AZ 85143 | 2007-12-17 |
| 1205814621 | Janet F Rinehart | Family Medicine | 30046 N Varnum Rd, San Tan Valley, AZ 85143 | 2006-01-05 |
| 1750629952 | Dustin M Germaine | Specialist/Technologist | 1462 E Poncho Ln, San Tan Valley, AZ 85143-3218 | 2013-01-22 |
| Find all providers in zip 85143 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316433444 | Good Hope Resources Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1320 W Angus Rd, San Tan Valley, AZ 85143-5108 | 2018-07-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356948954 | Forever Place LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4200 N Pebble Creek Pkwy Apt 2069, Goodyear, AZ 85395-9028 | 2020-10-06 |
| 1285245407 | Ams Living, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3058 E Nance St, Mesa, AZ 85213-1644 | 2020-08-11 |
| 1437768892 | Max Care Center LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2239 W Hasan Dr, Phoenix, AZ 85041-5312 | 2020-07-30 |
| 1265050876 | Arizona Alternative Support, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 36379 W El Greco St, Maricopa, AZ 85138-5323 | 2020-07-09 |
| 1255957304 | Benchmark Valley LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 7209 W Forest Grove Ave, Phoenix, AZ 85043-7303 | 2020-06-24 |
| 1265067052 | Benchmark Valley LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 7321 S 15th Dr, Phoenix, AZ 85041-6932 | 2020-03-12 |
| 1083249874 | Benchmark Valley LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1506 E Irwin Ave, Phoenix, AZ 85042-5618 | 2020-03-12 |
| 1861024069 | New Roots Residency LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3139 W Carson Rd, Phoenix, AZ 85041-6342 | 2020-02-06 |
| 1972149078 | Serenitybehavioralhealth.llc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 15202 N Flamenco Dr, Phoenix, AZ 85053-4872 | 2019-11-23 |
| 1952945370 | Natalie Miranda Contreras | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5717 S Southland Blvd Apt D, Tucson, AZ 85706-4241 | 2019-10-29 |
| Find all providers with the same taxonomy | ||||
| City | SAN TAN VALLEY |
| Zip Code | 85143 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.