Provider Demographics
NPI:1700601978
Name:MALCA CARE AND SUPPORT LLC
Entity type:Organization
Organization Name:MALCA CARE AND SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-288-1069
Mailing Address - Street 1:221 CHISWICK LOOP
Mailing Address - Street 2:
Mailing Address - City:STOCBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281
Mailing Address - Country:US
Mailing Address - Phone:516-288-1069
Mailing Address - Fax:
Practice Address - Street 1:221 CHISWICK LOOP
Practice Address - Street 2:
Practice Address - City:STOCBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281
Practice Address - Country:US
Practice Address - Phone:516-288-1069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health