Provider Demographics
NPI:1477301232
Name:MTK GROUP
Entity type:Organization
Organization Name:MTK GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-755-4138
Mailing Address - Street 1:24312 CARLTON CT
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-3719
Mailing Address - Country:US
Mailing Address - Phone:949-755-4138
Mailing Address - Fax:
Practice Address - Street 1:27075 CABOT RD STE 106
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7028
Practice Address - Country:US
Practice Address - Phone:949-755-4138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARING COMPANIONS REFERRAL AGENCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-07
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care