Organization
SHALOM BEHAVIORAL CARE LLC
Active
Organization
SHALOM BEHAVIORAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY VINCENT OLORUNSOLA FNP -BC (NURSE PRACTITIONER)
(623) 806-6864
Entity
Organization
Contact information
Practice address
35301 N BELGIAN BLUE CT, SAN TAN VALLEY, AZ 85143
(480) 687-0462
Mailing address
35301 N BELGIAN BLUE CT, SAN TAN VALLEY, AZ 85143-5497
(480) 687-0462
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
BH5490
AZ
Other
Enumeration date
08/18/2018
Last updated
08/28/2018
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