Basic Information
| Provider Information | |||||||||
| NPI: | 1346511425 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MALVERN INSTITUTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 521 PLYMOUTH RD | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | PLYMOUTH MEETING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194621638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4849040081 | ||||||||
| FaxNumber: | 6102652941 | ||||||||
| Practice Location | |||||||||
| Address1: | 4610 E STREET RD | ||||||||
| Address2: | |||||||||
| City: | TREVOSE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190536612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2676993000 | ||||||||
| FaxNumber: | 2676993012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2012 | ||||||||
| LastUpdateDate: | 01/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6109413348 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PROGRESSIONS COMPANIES, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.