Provider Demographics
NPI:1144402975
Name:MALCOM GROW
Entity Type:Organization
Organization Name:MALCOM GROW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TAYOOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-808-5466
Mailing Address - Street 1:503 SPECTATOR AVEUNE
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785
Mailing Address - Country:US
Mailing Address - Phone:301-808-5466
Mailing Address - Fax:
Practice Address - Street 1:711 ROMFORD DR
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-5940
Practice Address - Country:US
Practice Address - Phone:301-808-5466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD612879276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit