Provider Demographics
NPI:1427791581
Name:MALESHIA LLC
Entity type:Organization
Organization Name:MALESHIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-312-9239
Mailing Address - Street 1:542 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:PROSPECT PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19076-1201
Mailing Address - Country:US
Mailing Address - Phone:303-231-2923
Mailing Address - Fax:
Practice Address - Street 1:542 13TH AVE
Practice Address - Street 2:
Practice Address - City:PROSPECT PARK
Practice Address - State:PA
Practice Address - Zip Code:19076-1201
Practice Address - Country:US
Practice Address - Phone:302-312-9239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-17
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care