Provider Demographics
NPI:1487670584
Name:MACKMALTER ENTERPRISES INC
Entity Type:Organization
Organization Name:MACKMALTER ENTERPRISES INC
Other - Org Name:ALPHA HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-438-0309
Mailing Address - Street 1:205 BAILEY LN
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62812-1921
Mailing Address - Country:US
Mailing Address - Phone:618-438-0309
Mailing Address - Fax:618-438-4406
Practice Address - Street 1:205 BAILEY LN
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:IL
Practice Address - Zip Code:62812-1921
Practice Address - Country:US
Practice Address - Phone:618-438-0309
Practice Address - Fax:618-438-4406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
IL203000212332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL446436OtherHEALTHLINK
IL02827016OtherBCBS
IL072787OtherHEALTH ALLIANCE
IN200418050AMedicaid
IL072787OtherHEALTH ALLIANCE