Provider Demographics
NPI:1336199892
Name:MALCOLM EATON ENTERPRISES
Entity Type:Organization
Organization Name:MALCOLM EATON ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROL D
Authorized Official - Middle Name:SHERMAN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-235-7181
Mailing Address - Street 1:570 W LAMM RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-9629
Mailing Address - Country:US
Mailing Address - Phone:815-235-7181
Mailing Address - Fax:815-235-7180
Practice Address - Street 1:570 W LAMM RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-9629
Practice Address - Country:US
Practice Address - Phone:815-235-7181
Practice Address - Fax:815-235-7180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL95C002251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherFEIN