Provider Demographics
NPI:1942591805
Name:C.MALCMACHER
Entity Type:Organization
Organization Name:C.MALCMACHER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MALCMACHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MAGD
Authorized Official - Phone:440-892-1810
Mailing Address - Street 1:27239 WOLF RD
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-2020
Mailing Address - Country:US
Mailing Address - Phone:440-892-1810
Mailing Address - Fax:440-892-8747
Practice Address - Street 1:27239 WOLF RD
Practice Address - Street 2:
Practice Address - City:BAY VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44140-2020
Practice Address - Country:US
Practice Address - Phone:440-892-1810
Practice Address - Fax:440-892-8747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization