Provider Demographics
NPI:1194140103
Name:KACZOR ENTERPRISES INC
Entity type:Organization
Organization Name:KACZOR ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KEANON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-592-3643
Mailing Address - Street 1:2236 MCKINNON RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31535-3102
Mailing Address - Country:US
Mailing Address - Phone:912-592-3643
Mailing Address - Fax:912-393-1011
Practice Address - Street 1:55 DELLMONTE RD
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31535-6135
Practice Address - Country:US
Practice Address - Phone:912-592-3643
Practice Address - Fax:912-393-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034-023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport