Victor Weinstein Shalom House

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

2512455 Issued in OH

Legal business name

VICTOR WEINSTEIN SHALOM HOUSE

Doing business as

Shalom House Inc, Shalom House North

Practice address

1135 College Ave
Columbus, OH 43209-7802

Phone

(614) 239-1999

Fax

(614) 239-1367

NPI assigned

Apr 14, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Ruth Dodge, QMRP

Title

Administrator

Phone

(614) 239-1999

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Shalom House Inc, Shalom House North Doing business as

Tax ID family

Shalom House Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Shalom House South

  • Intellectual Disabilities Intermediate Care Facility
  • Columbus, OH
  • NPI 1912961806
  NPD tax ID

Locations

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609830611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1135 COLLEGE AVE",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432097802",
            "telephone_number": "614-239-1999",
            "fax_number": "614-239-1367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1135 COLLEGE AVE",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432097802",
            "telephone_number": "614-239-1999",
            "fax_number": "614-239-1367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTOR WEINSTEIN SHALOM HOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DODGE",
        "authorized_official_first_name": "RUTH",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "614-239-1999",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "QMRP"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "OH",
            "license": "2512455",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0656017",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shalom House Inc, Shalom House North",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cameryn Vickery
• Elizabeth Vickery, PH.D.
• Meghan Vickery, APRN-CNP
• Taylor Vickery
• Victor Dizon, D.O., Facos, Inc
• Aaron Robert Victor, MD, PHD
• Victory Hands Care Services LLC
• Victory Mental Health Services of Columbus
• Victoryhandshealthcare LLC
• Jorge Alberto Vidaurre, MD

• Intellectual Disabilities Intermediate Care Facility in Columbus, OH
• Providers in Columbus, OH by specialty
• Intellectual Disabilities Intermediate Care Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.