Provider Demographics
NPI:1679344519
Name:SHALOM INDUSTRIES
Entity type:Organization
Organization Name:SHALOM INDUSTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:I
Authorized Official - Last Name:NGASSAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-926-2219
Mailing Address - Street 1:6200 WOOD POND RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2263
Mailing Address - Country:US
Mailing Address - Phone:313-926-2219
Mailing Address - Fax:
Practice Address - Street 1:6200 WOOD POND RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2263
Practice Address - Country:US
Practice Address - Phone:313-926-2219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency
No253Z00000XAgenciesIn Home Supportive Care