# KLG MOBILE INTENSIVE CO LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952367807
- **Authorized official:** MR. KARL LEE GRIGGS (PRESIDENT CEO)
- **Authorized official phone:** (330) 337-4555

## Contact information

- **Practice address:** 1516 B SOUTH LINCOLN AVENUE, SALEM, OH 44460-4249
- **Practice address phone:** (330) 337-4555
- **Practice address fax:** (330) 337-4552
- **Mailing address:** 1516 B SOUTH LINCOLN AVENUE, SALEM, OH 44460-4249
- **Mailing address phone:** (330) 337-4555
- **Mailing address fax:** (330) 337-4552

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 150062 | OH | Yes |
| 343900000X | Non-emergency Medical Transport (VAN) | 155075 | OH | — |

## Other

- **Enumeration date:** 04/20/2006
- **Last updated:** 03/09/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2181071 | — | OH |