Provider Demographics
NPI:1275369811
Name:MICIL LLC
Entity type:Organization
Organization Name:MICIL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:POPOOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-300-0758
Mailing Address - Street 1:2908 DORTMUND DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-3199
Mailing Address - Country:US
Mailing Address - Phone:701-300-0758
Mailing Address - Fax:
Practice Address - Street 1:2908 DORTMUND DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-3199
Practice Address - Country:US
Practice Address - Phone:701-300-0758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health