Provider Demographics
NPI:1609551381
Name:MKSM INCORPORATED
Entity type:Organization
Organization Name:MKSM INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:757-610-2236
Mailing Address - Street 1:4001 VIRGINIA BEACH BLVD STE 117
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1759
Mailing Address - Country:US
Mailing Address - Phone:757-610-2236
Mailing Address - Fax:757-655-3639
Practice Address - Street 1:249 CENTRAL PARK AVE STE 300
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3271
Practice Address - Country:US
Practice Address - Phone:757-610-2236
Practice Address - Fax:757-300-5246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care