1700348208 NPI number — MALORI MCCLOSKEY QMHC

Table of content: MALORI MCCLOSKEY QMHC (NPI 1700348208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700348208 NPI number — MALORI MCCLOSKEY QMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCLOSKEY
Provider First Name:
MALORI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
QMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARR
Provider Other First Name:
MALORI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700348208
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 NORTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CURTICE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43412-9738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-705-6319
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3335 MEIJER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-347-0606
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 172V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)