Active NPI
Thad Malik
- Foster Care Agency
- Prescott, AZ
National Provider Identifier
1982177689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foster Care Agency
- License
- 9685638
- Practice address
- 1708 Sequoia Dr
Prescott, AZ 86301-1243 - Phone
- (248) 825-5715
- NPI assigned
- Jan 4, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foster Care Agency | 253J00000X | 9685638 | AZ | Primary |
Addresses
Primary practice location
1708 Sequoia Dr
Prescott, AZ 86301-1243
Mailing address
1708 Sequoia Dr
Prescott, AZ 86301-1243
Phone (248) 825-5715
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9685638 | AZ | MD | Foster Care Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1546560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1546560000000",
"number": "1982177689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1708 SEQUOIA DR",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "863011243",
"telephone_number": "248-825-5715"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1708 SEQUOIA DR",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "863011243",
"telephone_number": "248-825-5715"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALIK",
"first_name": "THAD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-01-04",
"last_updated": "2019-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "253J00000X",
"taxonomy_group": "",
"desc": "Foster Care Agency",
"state": "AZ",
"license": "9685638",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prescott, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.