# VILLAGE SHALOM, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316908163
- **Authorized official:** MR. MATTHEW EARL LEWIS (PRESIDENT/CEO)
- **Authorized official phone:** (913) 266-8400

## Contact information

- **Practice address:** 5500 W 123RD ST, OVERLAND PARK, KS 66209-3193
- **Practice address phone:** (913) 317-2600
- **Mailing address:** 5500 W 123RD ST, OVERLAND PARK, KS 66209-3193
- **Mailing address phone:** (913) 317-2600

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA0600X | Adult Day Care Clinic/Center | N046054 | KS | — |
| 310400000X | Assisted Living Facility | N046054 | KS | — |
| 311500000X | Alzheimer Center (Dementia Center) | N046054 | KS | — |
| 314000000X | Skilled Nursing Facility | N046054 | KS | Yes |

## Other

- **Enumeration date:** 03/31/2006
- **Last updated:** 01/28/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100112060A | — | KS |
| 01 | — | 90924016 | BCBS PROVIDER NUMBER | KS |