Provider Demographics
NPI:1720960818
Name:KBCM & SUPPORT BROKER SERVICES
Entity type:Organization
Organization Name:KBCM & SUPPORT BROKER SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-262-3464
Mailing Address - Street 1:631 E GARRISON BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4472
Mailing Address - Country:US
Mailing Address - Phone:704-215-5469
Mailing Address - Fax:
Practice Address - Street 1:631 E GARRISON BLVD STE C
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4472
Practice Address - Country:US
Practice Address - Phone:704-215-5469
Practice Address - Fax:704-396-6931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No251X00000XAgenciesSupports Brokerage