MEDICARE: JIBRON INT'L 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
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1407282619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JIBRON INT'L INC

Provider Business Mailing Address
First Line	:	1112 SWEET SPRING CT
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-7458
Country	:	US
Telephone Number	:	615-260-2431
Fax Number	:

Provider Business Practice Location Address
First Line	:	1112 SWEET SPRING CT
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-7458
Country	:	US
Telephone Number	:	615-260-2431
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. ADERONKE AKISANMI
Credential	:
Telephone Number	:	615-260-4074

Provider Enumeration Date	:	09/19/2013
Last Update Date	:	09/19/2013

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