Healthcare Provider Details

I. General information

NPI: 1275940231
Provider Name (Legal Business Name): MYKALA ENTERPRISES, LLCDBA RIGHT AT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 W MICHIGAN AVE STE 301B
JACKSON MI
49201-1900
US

IV. Provider business mailing address

755 W MICHIGAN AVE SUITE 301B
JACKSON MI
49201-1908
US

V. Phone/Fax

Practice location:
  • Phone: 517-768-0902
  • Fax: 517-768-0909
Mailing address:
  • Phone: 517-768-0902
  • Fax: 517-768-0909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2058229
License Number StateMI

VIII. Authorized Official

Name: MRS. KAY MARILYLN MYKALA
Title or Position: ADMINISTRATOR
Credential:
Phone: 517-768-0902