Healthcare Provider Details

I. General information

NPI: 1912732660
Provider Name (Legal Business Name): VALERIE MALONE CNA, QMA,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 S 2ND ST
ELKHART IN
46516-3238
US

IV. Provider business mailing address

421 S 2ND ST
ELKHART IN
46516-3238
US

V. Phone/Fax

Practice location:
  • Phone: 574-208-7974
  • Fax:
Mailing address:
  • Phone: 574-208-7974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number202109091521534
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: