Organization
SHALOM HOUSE SOUTH
Active
Other names
Shalom House Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RUTH DODGE QMRP (ADMINISTRATOR)
(614) 239-1999
Entity
Organization
Contact information
Practice address
1480 COLLEGE AVE, COLUMBUS, OH 43209-2888
(614) 338-2351
(614) 338-2353
Mailing address
1480 COLLEGE AVE, COLUMBUS, OH 43209-2888
(614) 338-2351
(614) 338-2353
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
2512963
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0899201
—
OH
Enumeration date
04/17/2006
Last updated
08/22/2020
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