Healthcare Provider Details

I. General information

NPI: 1023871878
Provider Name (Legal Business Name): MIKAB EMPIRE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KENNEDY AVE UNIT 2330
DANBURY CT
06810-5976
US

IV. Provider business mailing address

1 KENNEDY AVE UNIT 2330
DANBURY CT
06810-5976
US

V. Phone/Fax

Practice location:
  • Phone: 718-581-7133
  • Fax:
Mailing address:
  • Phone: 718-581-7133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: TAMIKA BIRT
Title or Position: OWNER
Credential:
Phone: 718-581-7133