Provider Demographics
NPI:1497583959
Name:RILEY, MALCOLM
Entity type:Individual
Prefix:
First Name:MALCOLM
Middle Name:
Last Name:RILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10979 REED HARTMAN HWY STE 312
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-2825
Mailing Address - Country:US
Mailing Address - Phone:260-418-7155
Mailing Address - Fax:
Practice Address - Street 1:10979 REED HARTMAN HWY STE 312
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-2825
Practice Address - Country:US
Practice Address - Phone:260-418-7155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide