Healthcare Provider Details

I. General information

NPI: 1669538419
Provider Name (Legal Business Name): MOKA CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3391 MERRIAM ST STE. 201
MUSKEGON MI
49444-3155
US

IV. Provider business mailing address

3391 MERRIAM ST STE. 201
MUSKEGON MI
49444-3155
US

V. Phone/Fax

Practice location:
  • Phone: 230-830-9376
  • Fax: 231-737-1464
Mailing address:
  • Phone: 230-830-9376
  • Fax: 231-737-1464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS ZMOLEK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 231-830-9376