Provider Demographics
NPI:1558641647
Name:MI2 VENTURES, LLC
Entity Type:Organization
Organization Name:MI2 VENTURES, LLC
Other - Org Name:FIRSTLIGHT HOMECARE OF AUSTIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:ONDERKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-276-2135
Mailing Address - Street 1:11615 ANGUS RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4078
Mailing Address - Country:US
Mailing Address - Phone:512-427-6213
Mailing Address - Fax:
Practice Address - Street 1:11615 ANGUS RD
Practice Address - Street 2:SUITE 109
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4078
Practice Address - Country:US
Practice Address - Phone:512-276-2135
Practice Address - Fax:512-276-2397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014512253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care