1861937237 NPI number — MALACHAI INVESTMENTS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861937237 NPI number — MALACHAI INVESTMENTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MALACHAI INVESTMENTS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MALACHAI LABORATORIES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861937237
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10,000 SE MAIN ST
Provider Second Line Business Mailing Address:
STE 360
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-253-4000
Provider Business Mailing Address Fax Number:
503-253-4002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10,000 SE MAIN ST
Provider Second Line Business Practice Location Address:
STE 360
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-253-4000
Provider Business Practice Location Address Fax Number:
503-253-4002
Provider Enumeration Date:
12/21/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BRETT
Authorized Official First Name:
DARELL
Authorized Official Middle Name:
CAMERON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
503-253-4000

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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