Provider Demographics
NPI:1508647041
Name:MALIB CARE INC
Entity Type:Organization
Organization Name:MALIB CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LIBERATUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MWANGOMBE
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, BSRC
Authorized Official - Phone:240-423-3331
Mailing Address - Street 1:3022 JAVIER RD STE 124
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3022 JAVIER RD STE 124
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4624
Practice Address - Country:US
Practice Address - Phone:240-423-3331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities