1114627635 NPI number — MY KIT FREE LLC

Table of content: (NPI 1114627635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114627635 NPI number — MY KIT FREE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MY KIT FREE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114627635
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6833 S DAYTON ST # 255
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWOOD VILLAGE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80112-3624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-691-0366
Provider Business Mailing Address Fax Number:
606-328-6128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5400 FORT ST STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRENTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48183-4630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-676-5353
Provider Business Practice Location Address Fax Number:
855-552-3776
Provider Enumeration Date:
03/03/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KOZLOW
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL/MANAGER
Authorized Official Telephone Number:
606-691-0366

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)