Provider Demographics
NPI:1275940231
Name:MYKALA ENTERPRISES, LLCDBA RIGHT AT HOME
Entity Type:Organization
Organization Name:MYKALA ENTERPRISES, LLCDBA RIGHT AT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:MARILYLN
Authorized Official - Last Name:MYKALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-768-0902
Mailing Address - Street 1:755 W MICHIGAN AVE
Mailing Address - Street 2:SUITE 301B
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1908
Mailing Address - Country:US
Mailing Address - Phone:517-768-0902
Mailing Address - Fax:517-768-0909
Practice Address - Street 1:744 W MICHIGAN AVE
Practice Address - Street 2:STE 301B
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1900
Practice Address - Country:US
Practice Address - Phone:517-768-0902
Practice Address - Fax:517-768-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2058229251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2058229Medicaid