Provider Demographics
NPI:1528206810
Name:MBK INC
Entity Type:Organization
Organization Name:MBK INC
Other - Org Name:MEADOW LAKE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:B
Authorized Official - Last Name:KAPELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-530-2794
Mailing Address - Street 1:17444 MEADOW LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-9181
Mailing Address - Country:US
Mailing Address - Phone:605-882-4388
Mailing Address - Fax:605-882-4388
Practice Address - Street 1:17444 MEADOW LAKE RD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-9181
Practice Address - Country:US
Practice Address - Phone:605-882-4388
Practice Address - Fax:605-882-4388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization