Provider Demographics
NPI:1710363700
Name:HOME MALONE HEALTHCARE AGENCY
Entity Type:Organization
Organization Name:HOME MALONE HEALTHCARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:774-223-0874
Mailing Address - Street 1:11 COLONIAL TER
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-3303
Mailing Address - Country:US
Mailing Address - Phone:774-223-0874
Mailing Address - Fax:
Practice Address - Street 1:11 COLONIAL TER
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-3303
Practice Address - Country:US
Practice Address - Phone:774-223-0874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health