Shalom Adult Family Home 1 LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

SHALOM ADULT FAMILY HOME 1 LLC

Practice address

1102 S 72ND St
Tacoma, WA 98408-3007

Phone

(253) 301-1875

Fax

(253) 301-1949

NPI assigned

Apr 29, 2024

Last updated

Apr 29, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Gloria Nansubuga, CNA

Title

Provider

Phone

(206) 501-0731

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1714348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714348800000",
    "number": "1477309607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 S 72ND ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984083007",
            "telephone_number": "253-301-1875",
            "fax_number": "253-301-1949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 S 72ND ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984083007",
            "telephone_number": "253-301-1875",
            "fax_number": "253-301-1949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHALOM ADULT FAMILY HOME 1 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-29",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-28",
        "status": "A",
        "authorized_official_last_name": "NANSUBUGA",
        "authorized_official_first_name": "GLORIA",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "206-501-0731",
        "authorized_official_credential": "CNA"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Viral S Shah, MD
• Ann M Shahan, BSN
• Sabrina Shaheen, M.D.
• Azima Shaji, MD
• Amirali Shakouripartovi, MD
• Shalom Springs Adult Family Home Inc.
• Zain Shamoon, LMFT
• Shanachie Psychological Services
• Guiselda B Shank, BSN RN
• Mamta Shankar, BPHARM

• Adult Care Home Facility in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Adult Care Home Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.