Mlckm, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

MLCKM, LLC

Practice address

158 Farmbrook Rd
Port Orange, FL 32127-6243

Phone

(386) 767-1613

NPI assigned

May 7, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Malgorzata Ptak

Title

Owner/Administrator

Phone

(386) 767-1613

Specialties & licenses 1

Addresses

Other names 1

• Harbor Oaks Golden Years Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557187200000",
    "number": "1881259547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "158 FARMBROOK RD",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321276243",
            "telephone_number": "386-767-1613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 FARMBROOK RD",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321276243",
            "telephone_number": "386-767-1613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MLCKM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-07",
        "last_updated": "2019-05-07",
        "status": "A",
        "authorized_official_last_name": "PTAK",
        "authorized_official_first_name": "MALGORZATA",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "386-767-1613"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harbor Oaks Golden Years",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.