Malibu Group LLC

Primary specialty

Other TechnicianTaxonomy code 247200000X

Legal business name

MALIBU GROUP LLC

Practice address

5258 Plainfield Ave NE
Grand Rapids, MI 49525-1092

Phone

(616) 635-2398

NPI assigned

Nov 27, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Corinn Nichols

Title

Manager

Phone

(616) 450-4125

Specialties & licenses 1

Addresses

Other names 1

• Remedy Lice Boutique Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1511740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1511740800000",
    "number": "1366956583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4075 YARROW DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5258 PLAINFIELD AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495251092",
            "telephone_number": "616-635-2398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALIBU GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-27",
        "last_updated": "2017-11-27",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "CORINN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "616-450-4125"
    },
    "taxonomies": [
        {
            "code": "247200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician, Other",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Remedy Lice Boutique",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sheri Ann Malcolm, PHARMD
• Maria Maldonado
• Olivia Male
• Thomas A Malec, M.D., P.C.
• Elizabeth J Maleski
• Carrie Malin, PT
• Melissa Malinoski, PA-C
• Kari Mae Malinowski, PA-C
• Chaitanya Malla, MD
• James Malleis, MD

• Other Technician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Other Technician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.