Provider Demographics
NPI:1275289589
Name:MK CARE CONNECTIONS LLC
Entity Type:Organization
Organization Name:MK CARE CONNECTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:KIILU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:909-441-9520
Mailing Address - Street 1:6814 WEST BRILES RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-7149
Mailing Address - Country:US
Mailing Address - Phone:909-441-9520
Mailing Address - Fax:
Practice Address - Street 1:11320 WEST ORANGE BLOSSOM LANE
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-3531
Practice Address - Country:US
Practice Address - Phone:909-441-9520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home