Sholom Community Alliance Home Health Care

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

355707 Issued in MN

Legal business name

SHOLOM COMMUNITY ALLIANCE HOME HEALTH CARE

Practice address

3620 Phillips Pkwy
St Louis Park, MN 55426-3700

Phone

(952) 939-1515

Fax

(952) 933-1485

NPI assigned

Jan 4, 2012

Organization subpart

Yes

Parent organization

SHOLOM COMMUNITY ALLIANCE HOME HEALTH CAREAs reported in NPPES

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

Authorized official

Name

Douglas Wyckoff

Title

Controller

Phone

(952) 939-1637

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Sholom Home Care Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Home health agency certification: CCN 248132

Legal name

SHOLOM COMMUNITY ALLIANCE HOME HEALTH CARE

Doing business as

SHOLOM HOME CARE

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Aug 1, 2013

Last certification

Aug 1, 2013

Ownership / control type

Non-Profit

Organization structure

CorporationNon-profit

Incorporated

Nov 1, 2001 in MN

Enrollment address

740 Kay Ave
Saint Paul, MN 55102-6014

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Sholom Community Alliance Home Health Care

  • Community Based Hospice Care Agency
  • St Louis Park, MN
  • NPI 1558529941

  7810061447

  Same PAC ID

Listed as

Sholom Home CareCCN 248132

Overall star rating

2.5 of 5

Ownership

Non-Profit

Certified

Aug 1, 2013

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Tax ID family

Sholom Community Alliance Home Health Care3 organizations share this tax ID, including this one

Part of

Sholom Community Alliance Home Health Care

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Sholom Community Alliance Home Health Care

  • Home Health Agency
  • St Louis Park, MN
  • NPI 1295704005
  NPD tax ID
• Sholom Community Alliance Home Health Care

  • Community Based Hospice Care Agency
  • St Louis Park, MN
  • NPI 1558529941
  NPD tax ID

All disclosed owners & managing parties 22

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Marc A Salita, MD

  • Internal Medicine Physician
  • Richfield, MN
  • NPI 1588626824

  Corporate Director

  CMS ownership

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Christine Duncan, M.D.

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1497730931

  Home health agency

  Care Compare affiliation
• Sarah C Maier, MD

  • Family Medicine Physician
  • Minneapolis, MN
  • NPI 1710953427

  Home health agency

  Care Compare affiliation

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

{
    "created_epoch": "1325635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713744000000",
    "number": "1386914588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3620 PHILLIPS PKWY",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554263700",
            "telephone_number": "952-939-1515",
            "fax_number": "952-933-1485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3620 PHILLIPS PKWY",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554263700",
            "telephone_number": "952-939-1515",
            "fax_number": "952-933-1485"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "740 Kay Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551026014",
            "country_code": "US",
            "telephone_number": "952-939-1515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SHOLOM COMMUNITY ALLIANCE HOME HEALTH CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHOLOM COMMUNITY ALLIANCE HOME HEALTH CARE",
        "enumeration_date": "2012-01-04",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A",
        "authorized_official_last_name": "WYCKOFF",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "952-939-1637"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MN",
            "license": "355707",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "271243100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sholom Home Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sholom Home Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• William S Shimp
• Jacob Shimpa, PHARM D
• Margaret Mary Shipitalo, OD, MS
• Omri Shochatovitz
• Sholom Community Alliance Home Health Care
• Sholom Community Alliance Home Health Care
• Sholom Community Alliance, LLC
• Sholom Home West Inc
• Joan Marie Shopbell, RD
• Benjamin Shoults

• Home Health Agency in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Home Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.