Provider Demographics
NPI:1225336266
Name:MALY'S SPECIAL SUPPORT INC
Entity Type:Organization
Organization Name:MALY'S SPECIAL SUPPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERROA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-338-3304
Mailing Address - Street 1:PO BOX 420793
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33242
Mailing Address - Country:US
Mailing Address - Phone:786-338-3304
Mailing Address - Fax:786-717-6420
Practice Address - Street 1:2646 NW 21 TERR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142
Practice Address - Country:US
Practice Address - Phone:786-523-4197
Practice Address - Fax:305-635-2328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-28
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL691763196Medicaid