Provider Demographics
NPI:1124336409
Name:D381G, INC.
Entity type:Organization
Organization Name:D381G, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-914-3999
Mailing Address - Street 1:4961 BABCOCK ST NE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-2800
Mailing Address - Country:US
Mailing Address - Phone:321-914-3999
Mailing Address - Fax:321-914-3996
Practice Address - Street 1:4961 BABCOCK ST NE
Practice Address - Street 2:SUITE 8
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-2800
Practice Address - Country:US
Practice Address - Phone:321-914-3999
Practice Address - Fax:321-914-3996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL231664253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care