Provider Demographics
NPI:1265824304
Name:CULLODEH LLC
Entity Type:Organization
Organization Name:CULLODEH LLC
Other - Org Name:LANSING COMFORCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MITKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-447-1318
Mailing Address - Street 1:405 WEST GREENLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910
Mailing Address - Country:US
Mailing Address - Phone:517-253-0438
Mailing Address - Fax:517-580-4224
Practice Address - Street 1:405 WEST GREENLAWN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910
Practice Address - Country:US
Practice Address - Phone:517-253-0438
Practice Address - Fax:517-580-4224
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CULLODEH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care