MEDICARE: KR2 ENTERPRISES LLC

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	310400000X	Assisted Living Facility	12816	FL

General Provider Information

NPI Number	:	1134571243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KR2 ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	1473 W 14TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-4942
Country	:	US
Telephone Number	:	904-353-1783
Fax Number	:

Provider Business Practice Location Address
First Line	:	1473 W 14TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-4942
Country	:	US
Telephone Number	:	904-353-1783
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	STEFFANIE LASHAWN JONES
Credential	:
Telephone Number	:	904-333-8820

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	07/13/2016

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