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General NPI Number Information
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NPI Number | 1750955209
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Entity Type | Organization
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Legal Business Name | MKALMA, LLC
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 1019 OLD SAINT MARYS RD
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City | PERRYVILLE
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State | MO
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Zip | 63775-1298
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Country | US
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Telephone | 573-768-5155
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Fax | 573-547-6246
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Provider Business Mailing Address
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Address Line | 1019 OLD SAINT MARYS RD
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City | PERRYVILLE
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State | MO
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Zip | 63775-1298
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Country | US
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Telephone | 573-768-5155
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Fax | 573-547-6246
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | DI DI TERBRAK
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Credential | RN
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Telephone | 573-768-5155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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