Shalom SD RTH LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

SHALOM SD RTH LLC

Practice address

1818 Fairview Ave
Fairview, OR 97024-3761

Phone

(404) 740-7257

Fax

(404) 740-7257

NPI assigned

Apr 27, 2026

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sibamo Bette Gaguro, RN

Title

Administrator

Phone

(404) 740-7257

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1777248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777248000000",
    "number": "1043156706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1818 FAIRVIEW AVE",
            "city": "FAIRVIEW",
            "state": "OR",
            "postal_code": "970243761",
            "telephone_number": "404-740-7257",
            "fax_number": "404-740-7257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 FAIRVIEW AVE",
            "city": "FAIRVIEW",
            "state": "OR",
            "postal_code": "970243761",
            "telephone_number": "404-740-7257",
            "fax_number": "404-740-7257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHALOM SD RTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-04-27",
        "last_updated": "2026-04-27",
        "certification_date": "2026-04-26",
        "status": "A",
        "authorized_official_last_name": "GAGURO",
        "authorized_official_first_name": "SIBAMO",
        "authorized_official_middle_name": "BETTE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "404-740-7257",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Illness Community Based Residential Treatment Facility in Fairview, OR
• Providers in Fairview, OR by specialty
• Mental Illness Community Based Residential Treatment Facility in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.