MEDICARE: RICKIA MALONE QMHS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		OH

General Provider Information

NPI Number	:	1912678111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICKIA MALONE QMHS

Provider Business Mailing Address
First Line	:	13422 KINSMAN RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-4410
Country	:	US
Telephone Number	:	216-283-4400
Fax Number	:	216-283-5359

Provider Business Practice Location Address
First Line	:	1425 HAYDEN AVE
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-1838
Country	:	US
Telephone Number	:	216-283-4400
Fax Number	:	216-283-5359

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2021
Last Update Date	:	09/27/2021

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