Provider Demographics
NPI:1255701645
Name:MYKIN HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:MYKIN HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBIK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:216-903-4688
Mailing Address - Street 1:84 N MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-3046
Mailing Address - Country:US
Mailing Address - Phone:888-525-3675
Mailing Address - Fax:
Practice Address - Street 1:84 N MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-3046
Practice Address - Country:US
Practice Address - Phone:888-525-3675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Yes251E00000XAgenciesHome Health
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child