Provider Demographics
NPI:1336925841
Name:MELCO RESIDENTIAL SERVICES
Entity type:Organization
Organization Name:MELCO RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTHERSIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-274-4029
Mailing Address - Street 1:4 CARILLON CIR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-2600
Mailing Address - Country:US
Mailing Address - Phone:407-274-4029
Mailing Address - Fax:
Practice Address - Street 1:4 CARILLON CIR
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-2600
Practice Address - Country:US
Practice Address - Phone:407-274-4029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare