NPIMap

Organization Active NPI

Shalom Behavioral Care LLC

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • San Tan Valley, AZ
National Provider Identifier
1619457785
Registry record updated Aug 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
BH5490 Issued in AZ
Legal business name
SHALOM BEHAVIORAL CARE LLC
Practice address
35301 N Belgian Blue CT
San Tan Valley, AZ 85143
Phone
(480) 687-0462
NPI assigned
Aug 18, 2018
Last updated
Aug 28, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2018

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

Authorized official

Name
Anthony Vincent Olorunsola, FNP -BCNPI 1205211802
Title
Nurse Practitioner
Phone
(623) 806-6864

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X BH5490 AZ Primary

Addresses

Primary practice location

35301 N Belgian Blue CT
San Tan Valley, AZ 85143

Mailing address

35301 N Belgian Blue CT
San Tan Valley, AZ 85143-5497
Phone (480) 687-0462

National Provider Directory

National Provider Directory
Tax ID family
Shalom Behavioral Care LLC2 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.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1534550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535414400000",
    "number": "1619457785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35301 N BELGIAN BLUE CT",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "851435497",
            "telephone_number": "480-687-0462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35301 N BELGIAN BLUE CT",
            "city": "SAN TAN VALLEY",
            "state": "AZ",
            "postal_code": "85143",
            "telephone_number": "480-687-0462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHALOM BEHAVIORAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-18",
        "last_updated": "2018-08-28",
        "status": "A",
        "authorized_official_last_name": "OLORUNSOLA",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "VINCENT",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "623-806-6864",
        "authorized_official_credential": "FNP -BC"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "AZ",
            "license": "BH5490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Tan Valley, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2018; 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.