Provider Demographics
NPI:1356957518
Name:SHALOM CLINIC FOR CHILDREN APMC
Entity type:Organization
Organization Name:SHALOM CLINIC FOR CHILDREN APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:OVAYOZA
Authorized Official - Middle Name:I
Authorized Official - Last Name:ADELEYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-356-7211
Mailing Address - Street 1:117 SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5039
Mailing Address - Country:US
Mailing Address - Phone:318-356-7211
Mailing Address - Fax:
Practice Address - Street 1:117 SOUTH DR
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5039
Practice Address - Country:US
Practice Address - Phone:318-356-7211
Practice Address - Fax:318-356-7226
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHALOM CLINIC FOR CHILDREN, APMC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty