Provider Demographics
NPI:1043053887
Name:KBA ENTERTAINMENT, LLC
Entity type:Organization
Organization Name:KBA ENTERTAINMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOSS
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:WRODUKUH
Authorized Official - Last Name:GARSAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-775-1202
Mailing Address - Street 1:751 NE 60TH ST APT 311
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IA
Mailing Address - Zip Code:50327-3313
Mailing Address - Country:US
Mailing Address - Phone:319-775-1202
Mailing Address - Fax:
Practice Address - Street 1:751 NE 60TH ST APT 311
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-3313
Practice Address - Country:US
Practice Address - Phone:319-775-1202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care