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General NPI Number Information
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NPI Number | 1558731554
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Entity Type | Organization
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Legal Business Name | MYKALA ENTERPRISED
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Dates
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Enumeration Date | 10/02/2015
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Last Update Date | 10/02/2015
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Provider Practice Location Address
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Address Line | 744 W MICHIGAN AVE STE 301B
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City | JACKSON
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State | MI
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Zip | 49201-1900
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Country | US
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Telephone | 517-768-0900
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Fax | 517-768-0900
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Provider Business Mailing Address
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Address Line | 744 W MICHIGAN AVE STE 301B
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City | JACKSON
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State | MI
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Zip | 49201-1900
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Country | US
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Telephone | 517-768-0900
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Fax | 517-768-0900
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KAY MYKALA
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Credential |
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Telephone | 734-768-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 251EE0000X
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License Number State | MI
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