Provider Demographics
NPI:1114421138
Name:BYKOTA 2 LLC
Entity Type:Organization
Organization Name:BYKOTA 2 LLC
Other - Org Name:VISITING ANGELS OF NORTHERN ARIZONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-220-4100
Mailing Address - Street 1:718 N HUMPHREYS ST STE 201
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3014
Mailing Address - Country:US
Mailing Address - Phone:928-220-4100
Mailing Address - Fax:
Practice Address - Street 1:718 N HUMPHREYS ST STE 201
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3014
Practice Address - Country:US
Practice Address - Phone:928-220-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO04G554253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care