MEDICARE: MALACHI BEHAVIORAL HEALTHCARE,INC

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	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care		NC

General Provider Information

NPI Number	:	1508006479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALACHI BEHAVIORAL HEALTHCARE,INC

Provider Business Mailing Address
First Line	:	200 VALENCIA DR
Second Line	:	SUITE 102&103
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6311
Country	:	US
Telephone Number	:	910-353-7600
Fax Number	:	910-353-7603

Provider Business Practice Location Address
First Line	:	200 VALENCIA DR
Second Line	:	SUITE 102&103
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6311
Country	:	US
Telephone Number	:	910-353-7600
Fax Number	:	910-353-7603

Authorized Official
Title or Position	:	OWNER
Name	:	MS. SHANNETTE MONIQUE GRAY
Credential	:
Telephone Number	:	910-353-7600

Provider Enumeration Date	:	03/04/2009
Last Update Date	:	03/04/2009

Similar Medicare Providers

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Practice Location Address:

200 VALENCIA DR # SR
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28546-6311

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1043296767 — MRS. BARBARA SUE HILL MSW LCSW
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200 VALENCIA DR , SUITE 108
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1558426213 — MRS. JACQUELINE FADEYI-BRYANT LCSW
Practice Location Address:

200 VALENCIA DR
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28546-6311

Practice Phone: 910-353-3060
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1831213222 — MRS. TWYNA L BELL M.A., LPC
Practice Location Address:

200 VALENCIA DR , SUITE 160
JACKSONVILLE, NC
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1952574865 — MR. JAMES R POE LPC
Practice Location Address:

200 VALENCIA DR , SUITE 123
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1053578104 — A STEP ABOVE THERAPEUTIC SERVICES, INC.
Practice Location Address:

200 VALENCIA DR , SUITE 127
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