Provider Demographics
NPI:1215626767
Name:M GIBBS WORKFORCE KERVIN LLC
Entity type:Organization
Organization Name:M GIBBS WORKFORCE KERVIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KERVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-825-1784
Mailing Address - Street 1:PO BOX 930013
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11693-0013
Mailing Address - Country:US
Mailing Address - Phone:516-518-4506
Mailing Address - Fax:
Practice Address - Street 1:21503 JAMAICA AVE # 1078
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1783
Practice Address - Country:US
Practice Address - Phone:516-518-4506
Practice Address - Fax:929-299-1525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty