Provider Demographics
NPI:1306224407
Name:THE KENNEDY GROUP
Entity Type:Organization
Organization Name:THE KENNEDY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BEONKO
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-722-1800
Mailing Address - Street 1:112 KINGS WAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-3500
Mailing Address - Country:US
Mailing Address - Phone:757-722-1800
Mailing Address - Fax:757-722-1900
Practice Address - Street 1:112 KINGS WAY
Practice Address - Street 2:SUITE C
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-3500
Practice Address - Country:US
Practice Address - Phone:757-722-1800
Practice Address - Fax:757-722-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health