Provider Demographics
NPI:1396958518
Name:MALONE, GLEAH R
Entity type:Individual
Prefix:
First Name:GLEAH
Middle Name:R
Last Name:MALONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4384 STATE ROUTE 522
Mailing Address - Street 2:
Mailing Address - City:PEDRO
Mailing Address - State:OH
Mailing Address - Zip Code:45659-8963
Mailing Address - Country:US
Mailing Address - Phone:740-532-0785
Mailing Address - Fax:
Practice Address - Street 1:6405 STATE ROUTE 141
Practice Address - Street 2:
Practice Address - City:KITTS HILL
Practice Address - State:OH
Practice Address - Zip Code:45645-9038
Practice Address - Country:US
Practice Address - Phone:740-533-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2689685Medicaid