Provider Demographics
NPI:1134646052
Name:MKL LLC
Entity Type:Organization
Organization Name:MKL LLC
Other - Org Name:FIRSTLIGHT HOME CARE OF CENTRAL ND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-881-0101
Mailing Address - Street 1:126 2ND AVE SW STE 111
Mailing Address - Street 2:
Mailing Address - City:RUGBY
Mailing Address - State:ND
Mailing Address - Zip Code:58368-1700
Mailing Address - Country:US
Mailing Address - Phone:701-881-0101
Mailing Address - Fax:
Practice Address - Street 1:126 2ND AVE SW STE 111
Practice Address - Street 2:
Practice Address - City:RUGBY
Practice Address - State:ND
Practice Address - Zip Code:58368-1700
Practice Address - Country:US
Practice Address - Phone:701-881-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MKL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health