Healthcare Provider Details

I. General information

NPI: 1225851348
Provider Name (Legal Business Name): KARA MININES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 WALBRIDGE ST APT 203
KALAMAZOO MI
49007-3517
US

IV. Provider business mailing address

714 WALBRIDGE ST APT 203
KALAMAZOO MI
49007-3517
US

V. Phone/Fax

Practice location:
  • Phone: 813-394-8275
  • Fax:
Mailing address:
  • Phone: 813-394-8275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALYCIA MININES
Title or Position: OWNER
Credential:
Phone: 813-394-8275