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General NPI Number Information
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NPI Number | 1649923541
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Entity Type | Organization
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Legal Business Name | KBG SUPPORTS & SERVICES LLC,
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Dates
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Enumeration Date | 01/31/2022
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Last Update Date | 01/31/2022
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Provider Practice Location Address
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Address Line | 3003 SW 168TH LOOP
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City | OCALA
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State | FL
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Zip | 34473-4128
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Country | US
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Telephone | 352-653-9488
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Fax | 352-307-2841
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Provider Business Mailing Address
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Address Line | 3003 SW 168TH LOOP
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City | OCALA
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State | FL
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Zip | 34473-4128
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Country | US
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Telephone | 352-653-9488
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Fax | 352-307-2841
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Authorized Official
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Title or Position | TREASURER & AMBR
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Name | MS. JUNEANN ISAACS-BENJAMIN
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Credential |
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Telephone | 352-653-9488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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