Provider Demographics
NPI:1306282272
Name:P.G. BUILDERS, INC.
Entity type:Organization
Organization Name:P.G. BUILDERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KEBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-346-1902
Mailing Address - Street 1:8044 SAVAGE GUILFORD RD
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:MD
Mailing Address - Zip Code:20794-9674
Mailing Address - Country:US
Mailing Address - Phone:301-346-1902
Mailing Address - Fax:301-470-2832
Practice Address - Street 1:7805 OLD GEORGETOWN RD STE 203
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2460
Practice Address - Country:US
Practice Address - Phone:301-346-1902
Practice Address - Fax:301-470-2832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA20739171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9802011-00Medicaid
MD5982011-00OtherNPI # OLDER ADULTS
MD980200200OtherLIVING AT HOME PROVIDER #