Provider Demographics
NPI:1508837444
Name:MICKS ENTERPRISES
Entity Type:Organization
Organization Name:MICKS ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:N
Authorized Official - Last Name:NKWOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-759-1368
Mailing Address - Street 1:13122 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-4645
Mailing Address - Country:US
Mailing Address - Phone:818-759-1368
Mailing Address - Fax:818-759-1369
Practice Address - Street 1:13122 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-4645
Practice Address - Country:US
Practice Address - Phone:818-759-1368
Practice Address - Fax:818-759-1369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103280332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4306520001Medicare ID - Type Unspecified