Provider Demographics
NPI:1669538419
Name:MOKA CORPORATION
Entity type:Organization
Organization Name:MOKA CORPORATION
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 1:3391 MERRIAM ST
Mailing Address - Street 2:STE. 201
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3155
Mailing Address - Country:US
Mailing Address - Phone:230-830-9376
Mailing Address - Fax:231-737-1464
Practice Address - Street 1:3391 MERRIAM ST
Practice Address - Street 2:STE. 201
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-3155
Practice Address - Country:US
Practice Address - Phone:230-830-9376
Practice Address - Fax:231-737-1464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities