Provider Demographics
NPI:1396975942
Name:MALACHI BEHAVIORAL HEATHCARE,INC
Entity type:Organization
Organization Name:MALACHI BEHAVIORAL HEATHCARE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNETTE
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-353-7600
Mailing Address - Street 1:200 VALENCIA DR
Mailing Address - Street 2:SUITE 102&103
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6311
Mailing Address - Country:US
Mailing Address - Phone:910-353-7600
Mailing Address - Fax:
Practice Address - Street 1:205 W BAYSHORE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5339
Practice Address - Country:US
Practice Address - Phone:910-353-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services