Provider Demographics
NPI:1013564491
Name:LBENHOLDINGS
Entity Type:Organization
Organization Name:LBENHOLDINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MAKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-330-3219
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63601-0012
Mailing Address - Country:US
Mailing Address - Phone:573-330-3219
Mailing Address - Fax:573-431-4874
Practice Address - Street 1:301 WATTS ST
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:MO
Practice Address - Zip Code:63601-1839
Practice Address - Country:US
Practice Address - Phone:573-330-3219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities