Provider Demographics
NPI:1093984353
Name:MALICORP
Entity Type:Organization
Organization Name:MALICORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:FUSELIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-574-2229
Mailing Address - Street 1:722 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:TALLULAH
Mailing Address - State:LA
Mailing Address - Zip Code:71282-4533
Mailing Address - Country:US
Mailing Address - Phone:318-574-2229
Mailing Address - Fax:318-574-2219
Practice Address - Street 1:722 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-4533
Practice Address - Country:US
Practice Address - Phone:318-574-2229
Practice Address - Fax:318-574-2219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health