Provider Demographics
NPI:1508921198
Name:MALVERN COMMUNITY HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:MALVERN COMMUNITY HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP, FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-941-3390
Mailing Address - Street 1:512 TOWNSHIP LINE RD STE 115
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-2700
Mailing Address - Country:US
Mailing Address - Phone:610-941-3391
Mailing Address - Fax:610-941-3391
Practice Address - Street 1:512 TOWNSHIP LINE RD STE 115
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2700
Practice Address - Country:US
Practice Address - Phone:610-941-3391
Practice Address - Fax:610-941-3391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA212730261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007742570014Medicaid
PA1007742570014Medicaid