MEDICARE: MALONEGROVE FAMILY CARE & REHABILITATION LLC

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1093427577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALONEGROVE FAMILY CARE & REHABILITATION LLC

Provider Business Mailing Address
First Line	:	6502 CENTRE PLACE CIR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-2937
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3305 NORTH ST
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-2690
Country	:	US
Telephone Number	:	832-661-7501
Fax Number	:

Authorized Official
Title or Position	:	CHEIF OPERATIONS OFFICER
Name	:	APRIL HENRY
Credential	:
Telephone Number	:	832-661-7501

Provider Enumeration Date	:	12/15/2022
Last Update Date	:	12/15/2022

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