# SHALOM ADULT FAMILY HOME 1 LLC

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

## Provider details

- **NPI number:** 1477309607
- **Authorized official:** GLORIA NANSUBUGA CNA (PROVIDER)
- **Authorized official phone:** (206) 501-0731

## Contact information

- **Practice address:** 1102 S 72ND ST, TACOMA, WA 98408-3007
- **Practice address phone:** (253) 301-1875
- **Practice address fax:** (253) 301-1949
- **Mailing address:** 1102 S 72ND ST, TACOMA, WA 98408-3007
- **Mailing address phone:** (253) 301-1875
- **Mailing address fax:** (253) 301-1949

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 04/29/2024
- **Last updated:** 04/29/2024