MEDICARE: KENNETH JOSEPH SIBLEY

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1477219558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH JOSEPH SIBLEY

Provider Business Mailing Address
First Line	:	150 HOOVER AVE APT 153
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6835
Country	:	US
Telephone Number	:	725-520-9108
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 HOOVER AVE APT 153
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6835
Country	:	US
Telephone Number	:	725-520-9108
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2021
Last Update Date	:	11/12/2021

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Directions to “ KENNETH JOSEPH SIBLEY ” Practice Location

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