Provider Demographics
NPI:1972255768
Name:MALKIA'S HERBS FOR LIFE LLC
Entity Type:Organization
Organization Name:MALKIA'S HERBS FOR LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTALE
Authorized Official - Middle Name:F
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:BSN RN
Authorized Official - Phone:910-634-4905
Mailing Address - Street 1:382 ARCHIE JACOBS LN
Mailing Address - Street 2:
Mailing Address - City:CLARKTON
Mailing Address - State:NC
Mailing Address - Zip Code:28433-9537
Mailing Address - Country:US
Mailing Address - Phone:910-634-4905
Mailing Address - Fax:
Practice Address - Street 1:382 ARCHIE JACOBS LN
Practice Address - Street 2:
Practice Address - City:CLARKTON
Practice Address - State:NC
Practice Address - Zip Code:28433-9537
Practice Address - Country:US
Practice Address - Phone:910-634-4905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-22
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC256227OtherREGISTERED NURSE