Provider Demographics
NPI:1790918068
Name:THE MALACHI HOUSE, INC.
Entity Type:Organization
Organization Name:THE MALACHI HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-275-2500
Mailing Address - Street 1:PO BOX 20803
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27420-0803
Mailing Address - Country:US
Mailing Address - Phone:336-275-2500
Mailing Address - Fax:336-275-4000
Practice Address - Street 1:507 BALBOA ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6405
Practice Address - Country:US
Practice Address - Phone:336-275-2500
Practice Address - Fax:336-275-4000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL078232324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility