Provider Demographics
NPI:1033604020
Name:MODAYIL ENTERPRISES, LLC
Entity Type:Organization
Organization Name:MODAYIL ENTERPRISES, LLC
Other - Org Name:RIGHT AT HOME SPRINGFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHWIN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:MODAYIL
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, MPH
Authorized Official - Phone:417-350-1004
Mailing Address - Street 1:1927 S NATIONAL AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2279
Mailing Address - Country:US
Mailing Address - Phone:417-350-1004
Mailing Address - Fax:
Practice Address - Street 1:1927 S NATIONAL AVE STE C
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2279
Practice Address - Country:US
Practice Address - Phone:417-350-1004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOBUS2017-01463253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care