NPIMap

Organization Active NPI

Shalom Behavioral House, LLC

  • Community/Behavioral Health Agency
  • Laveen, AZ
National Provider Identifier
1396508446
Registry record updated Feb 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
SHALOM BEHAVIORAL HOUSE, LLC
Practice address
7718 S 69TH Dr
Laveen, AZ 85339-3432
Phone
(602) 477-9416
NPI assigned
Feb 1, 2024
Organization subpart
Yes
Parent organization
SHALOM BEHAVIORAL HOUSE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 1, 2024

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

Authorized official

Name
Aime Mukura Linda Minega Shabani, BHT
Title
Administrator
Phone
(602) 477-9416

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

7718 S 69TH Dr
Laveen, AZ 85339-3432

Mailing address

11063 W Virginia Ave
Avondale, AZ 85392-5889
Phone (602) 477-9416

Other names 1

  • PRINCE MICAH HOUSE Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Benedicta House3 organizations share this tax ID, including this one
Part of
Benedicta House

Other organizations with this tax ID 2

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1706745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706745600000",
    "number": "1396508446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11063 W VIRGINIA AVE",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853925889",
            "telephone_number": "602-477-9416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7718 S 69TH DR",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853393432",
            "telephone_number": "602-477-9416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHALOM BEHAVIORAL HOUSE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHALOM BEHAVIORAL HOUSE, LLC",
        "enumeration_date": "2024-02-01",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A",
        "authorized_official_last_name": "MINEGA SHABANI",
        "authorized_official_first_name": "AIME",
        "authorized_official_middle_name": "MUKURA LINDA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "602-477-9416",
        "authorized_official_credential": "BHT"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PRINCE MICAH HOUSE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Laveen, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2024; 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.