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General NPI Number Information
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NPI Number | 1245497551
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Entity Type | Organization
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Legal Business Name | KBS WALTER GROUP LLC
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 5155 US HIGHWAY 1 S
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-7855
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Country | US
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Telephone | 904-797-5027
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Fax | 904-797-5577
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Provider Business Mailing Address
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Address Line | 5155 US HIGHWAY 1 S
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-7855
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Country | US
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Telephone | 904-797-5027
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Fax | 904-797-5577
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | MR. WILLIAM ROBERT WALTER
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Credential |
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Telephone | 904-797-5027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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