Provider Demographics
NPI:1649923541
Name:KBG SUPPORTS & SERVICES LLC,
Entity type:Organization
Organization Name:KBG SUPPORTS & SERVICES LLC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER & AMBR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUNEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ISAACS-BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-653-9488
Mailing Address - Street 1:3003 SW 168TH LOOP
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34473-4128
Mailing Address - Country:US
Mailing Address - Phone:352-653-9488
Mailing Address - Fax:352-307-2841
Practice Address - Street 1:3003 SW 168TH LOOP
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34473-4128
Practice Address - Country:US
Practice Address - Phone:352-653-9488
Practice Address - Fax:352-307-2841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management