Organization
MIKOUIS ENTERPRISES, INC., DBA SUNRISE HOMES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JEANNETTE MIKOUIS LNHA, RD/LD, RN (ADMINISTRATOR)
(330) 424-1418
Entity
Organization
Contact information
Practice address
38655 SALTWELL RD, LISBON, OH 44432-8348
(330) 424-1418
(330) 424-1920
Mailing address
38655 SALTWELL RD, P.O. BOX 329, LISBON, OH 44432-8348
(330) 424-1418
(330) 424-1920
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
24817
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0115048
—
OH
Enumeration date
01/05/2008
Last updated
01/05/2008
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