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General NPI Number Information
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NPI Number | 1790918068
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Entity Type | Organization
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Legal Business Name | THE MALACHI HOUSE, INC.
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Dates
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Enumeration Date | 09/02/2009
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Last Update Date | 09/08/2009
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Provider Practice Location Address
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Address Line | 507 BALBOA ST
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City | GREENSBORO
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State | NC
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Zip | 27405-6405
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Country | US
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Telephone | 336-275-2500
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Fax | 336-275-4000
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Provider Business Mailing Address
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Address Line | PO BOX 20803
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City | GREENSBORO
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State | NC
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Zip | 27420-0803
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Country | US
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Telephone | 336-275-2500
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Fax | 336-275-4000
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CLIFF LOVICK
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Credential |
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Telephone | 336-275-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | MHL078232
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License Number State | NC
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