Organization
SHALOM HERITAGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID ADEBAYO OGUNTOLA (MANAGING DIRECTOR)
(480) 845-9165
Entity
Organization
Contact information
Practice address
6748 S DENNIS DR, TEMPE, AZ 85283-5426
(480) 845-9165
Mailing address
6748 S DENNIS DR, TEMPE, AZ 85283-5426
(480) 845-9165
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
156294
—
AZ
Enumeration date
12/19/2022
Last updated
12/19/2022
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