Healthcare Provider Details

I. General information

NPI: 1609551381
Provider Name (Legal Business Name): MKSM INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 CENTRAL PARK AVE STE 300
VIRGINIA BEACH VA
23462-3271
US

IV. Provider business mailing address

4001 VIRGINIA BEACH BLVD STE 117
VIRGINIA BEACH VA
23452-1759
US

V. Phone/Fax

Practice location:
  • Phone: 757-610-2236
  • Fax: 757-300-5246
Mailing address:
  • Phone: 757-610-2236
  • Fax: 757-655-3639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. BENJAMIN FRANKLIN SAWYER JR.
Title or Position: PRESIDENT
Credential:
Phone: 757-610-2236