Provider Demographics
NPI:1992195630
Name:MOKA
Entity Type:Organization
Organization Name:MOKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZMOLEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-830-9376
Mailing Address - Street 1:5281 CLYDE PARK AVE SW
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-9506
Mailing Address - Country:US
Mailing Address - Phone:616-719-4263
Mailing Address - Fax:616-719-4267
Practice Address - Street 1:5281 CLYDE PARK AVE SW
Practice Address - Street 2:SUITE 2
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-9506
Practice Address - Country:US
Practice Address - Phone:616-719-4263
Practice Address - Fax:616-719-4267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802066082251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management