Provider Demographics
NPI:1578391983
Name:KLBNATIONAL LLC
Entity type:Organization
Organization Name:KLBNATIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-529-8053
Mailing Address - Street 1:558 SUMMIT TRL
Mailing Address - Street 2:
Mailing Address - City:SANTAQUIN
Mailing Address - State:UT
Mailing Address - Zip Code:84655-5684
Mailing Address - Country:US
Mailing Address - Phone:949-529-8053
Mailing Address - Fax:
Practice Address - Street 1:558 SUMMIT TRL
Practice Address - Street 2:
Practice Address - City:SANTAQUIN
Practice Address - State:UT
Practice Address - Zip Code:84655-5684
Practice Address - Country:US
Practice Address - Phone:949-529-8053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies