Organization
SHALOM HOUSE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY HAYNES-RODGERS (EXECUTIVE DIRECTOR)
(207) 874-1080
Entity
Organization
Contact information
Practice address
106 GILMAN ST, PORTLAND, ME 04102-3034
(207) 874-1080
(207) 874-1077
Mailing address
106 GILMAN ST, PORTLAND, ME 04102-3034
(207) 874-1080
(207) 874-1077
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
229743
ME
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
229743
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16780000
—
ME
05
—
167860101
—
ME
Enumeration date
07/06/2005
Last updated
01/23/2009
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