Provider Demographics
NPI:1558731554
Name:MYKALA ENTERPRISED
Entity Type:Organization
Organization Name:MYKALA ENTERPRISED
Other - Org Name:RIGHT AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MYKALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-768-0900
Mailing Address - Street 1:744 W MICHIGAN AVE STE 301B
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1900
Mailing Address - Country:US
Mailing Address - Phone:517-768-0900
Mailing Address - Fax:517-768-0900
Practice Address - Street 1:744 W MICHIGAN AVE STE 301B
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1900
Practice Address - Country:US
Practice Address - Phone:517-768-0900
Practice Address - Fax:517-768-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251EE0000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2058229Medicaid