Provider Demographics
NPI:1861090102
Name:SBP INTEGRATED CARE LLC
Entity type:Organization
Organization Name:SBP INTEGRATED CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFSTADTER-DUKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:912-658-5883
Mailing Address - Street 1:310 EISENHOWER DR STE 5
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2632
Mailing Address - Country:US
Mailing Address - Phone:912-658-5883
Mailing Address - Fax:912-436-6835
Practice Address - Street 1:310 EISENHOWER DR STE 16
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2632
Practice Address - Country:US
Practice Address - Phone:912-436-6789
Practice Address - Fax:912-658-5883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty