Healthcare Provider Details

I. General information

NPI: 1093155186
Provider Name (Legal Business Name): MALOY HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26280 HUNTINGTON ST
ROSEVILLE MI
48066-3439
US

IV. Provider business mailing address

26280 HUNTINGTON ST
ROSEVILLE MI
48066-3439
US

V. Phone/Fax

Practice location:
  • Phone: 313-633-3555
  • Fax: 586-776-7915
Mailing address:
  • Phone: 313-633-3555
  • Fax: 586-776-7915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAS500286652
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberAS500286652
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License NumberAS500286652
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License NumberAS500286652
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License NumberAS500286652
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberAS500286652
License Number StateMI

VIII. Authorized Official

Name: MS. GABRIELL MALOY
Title or Position: PROVIDER
Credential:
Phone: 313-633-3555