NPIMap

Organization Active NPI

Shalom Behavioral Care LLC

  • Psychiatric Residential Treatment Facility
  • Florence, AZ
National Provider Identifier
1720650583
Registry record updated Jul 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X
Legal business name
SHALOM BEHAVIORAL CARE LLC
Practice address
10612 E Marigold LN
Florence, AZ 85132-7320
Phone
(480) 684-2004
Fax
(480) 582-6043
NPI assigned
Jul 12, 2021
Last updated
Jul 12, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
SHALOM BEHAVIORAL CARE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 12, 2021

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

Authorized official

Name
Anthony Vincent OlorunsolaNPI 1205211802
Title
Statutory Officer
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
Psychiatric Residential Treatment Facility 323P00000X Primary

Addresses

Primary practice location

10612 E Marigold LN
Florence, AZ 85132-7320

Mailing address

10612 E Marigold LN
Florence, AZ 85132-7320
Phone (480) 684-2004

National Provider Directory

National Provider Directory
Tax ID family
Shalom Behavioral Care LLC2 organizations share this tax ID, including this one
Part of
Shalom Behavioral Care LLC

Other organizations with this tax ID 1

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.

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": "1626048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626048000000",
    "number": "1720650583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10612 E MARIGOLD LN",
            "city": "FLORENCE",
            "state": "AZ",
            "postal_code": "851327320",
            "telephone_number": "480-684-2004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10612 E MARIGOLD LN",
            "city": "FLORENCE",
            "state": "AZ",
            "postal_code": "851327320",
            "telephone_number": "480-684-2004",
            "fax_number": "480-582-6043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHALOM BEHAVIORAL CARE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHALOM BEHAVIORAL CARE, LLC",
        "enumeration_date": "2021-07-12",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A",
        "authorized_official_last_name": "OLORUNSOLA",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "VINCENT",
        "authorized_official_title_or_position": "STATUTORY OFFICER",
        "authorized_official_telephone_number": "623-806-6864"
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; 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.