Provider Demographics
NPI:1194856138
Name:MALICORP
Entity Type:Organization
Organization Name:MALICORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:FUSELIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-993-2005
Mailing Address - Street 1:100 TOULOUSE DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-5132
Mailing Address - Country:US
Mailing Address - Phone:337-993-2005
Mailing Address - Fax:
Practice Address - Street 1:100 TOULOUSE DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-5132
Practice Address - Country:US
Practice Address - Phone:337-993-2005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4504110251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1460745Medicaid