MEDICARE: KBR, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	5443PCS-2	NV

General Provider Information

NPI Number	:	1821350661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KBR, INC.

Provider Business Mailing Address
First Line	:	2340 PASEO DEL PRADO
Second Line	:	SUITE D112
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4360
Country	:	US
Telephone Number	:	702-796-6393
Fax Number	:	702-796-6392

Provider Business Practice Location Address
First Line	:	2340 PASEO DEL PRADO
Second Line	:	SUITE D112
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4360
Country	:	US
Telephone Number	:	702-796-6393
Fax Number	:	702-796-6392

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. LAVONNE REPPERT
Credential	:
Telephone Number	:	702-796-6393

Provider Enumeration Date	:	06/07/2012
Last Update Date	:	06/07/2012

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