Provider Demographics
NPI:1265131817
Name:SHALOM HERITAGE BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:SHALOM HERITAGE BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ADENIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:OPEJIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-845-9165
Mailing Address - Street 1:6748 S DENNIS DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-5426
Mailing Address - Country:US
Mailing Address - Phone:480-845-9165
Mailing Address - Fax:
Practice Address - Street 1:1232 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1511
Practice Address - Country:US
Practice Address - Phone:480-845-8165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty