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General NPI Number Information
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NPI Number | 1477863355
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Entity Type | Organization
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Legal Business Name | MALACHI HOME CARE,INC
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Dates
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Enumeration Date | 10/13/2010
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Last Update Date | 10/13/2010
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Provider Practice Location Address
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Address Line | 200 VALENCIA DR SUITE 103
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City | JACKSONVILLE
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State | NC
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Zip | 28546-6311
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Country | US
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Telephone | 910-539-8549
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1733
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City | JACKSONVILLE
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State | NC
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Zip | 28541-1733
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Country | US
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Telephone | 910-539-8549
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. SHANNETTE MONIQUE GRAY
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Credential |
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Telephone | 910-539-8549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State | NC
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