Provider Demographics
NPI:1972373892
Name:MALCOLM FAMILY CARE HOUSE LLC
Entity Type:Organization
Organization Name:MALCOLM FAMILY CARE HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DAYJHA
Authorized Official - Middle Name:MONA'
Authorized Official - Last Name:MALCOLM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-249-6937
Mailing Address - Street 1:172 E MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-5181
Mailing Address - Country:US
Mailing Address - Phone:864-249-6937
Mailing Address - Fax:
Practice Address - Street 1:172 E MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-5181
Practice Address - Country:US
Practice Address - Phone:864-249-6937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty