Provider Demographics
NPI:1710017124
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:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-438-0309
Mailing Address - Street 1:603 PUBLIC SQUARE
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:IL
Mailing Address - Zip Code:61812-2332
Mailing Address - Country:US
Mailing Address - Phone:618-438-0309
Mailing Address - Fax:618-438-4406
Practice Address - Street 1:301 RUSHING DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3749
Practice Address - Country:US
Practice Address - Phone:618-998-9250
Practice Address - Fax:618-998-9286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3857940002Medicare NSC