Provider Demographics
NPI:1508071804
Name:MALANER EDWARDS GALLOW
Entity Type:Organization
Organization Name:MALANER EDWARDS GALLOW
Other - Org Name:PRECIOUS LIFE CARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MALANER
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-363-4344
Mailing Address - Street 1:3485 FAUBOURG RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70589-5512
Mailing Address - Country:US
Mailing Address - Phone:337-363-4344
Mailing Address - Fax:337-363-4377
Practice Address - Street 1:3485 FAUBOURG RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:LA
Practice Address - Zip Code:70589-5512
Practice Address - Country:US
Practice Address - Phone:337-363-4344
Practice Address - Fax:337-363-4377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1174858Medicaid