=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275940231
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MYKALA ENTERPRISES, LLCDBA RIGHT AT HOME
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2014
-----------------------------------------------------
Last Update Date | 10/13/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 744 W MICHIGAN AVE STE 301B
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49201-1900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-768-0902
-----------------------------------------------------
Fax | 517-768-0909
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 755 W MICHIGAN AVE SUITE 301B
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49201-1908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-768-0902
-----------------------------------------------------
Fax | 517-768-0909
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. KAY MARILYLN MYKALA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 517-768-0902
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 2058229
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------