MEDICARE: KENNEDY BUILDING SOLUTIONS, 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	171WH0202X	Home Modifications Contractor	ROC 248732	AZ

General Provider Information

NPI Number	:	1528213600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNEDY BUILDING SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	2430 W SUNKIST RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85755-9711
Country	:	US
Telephone Number	:	520-544-9614
Fax Number	:

Provider Business Practice Location Address
First Line	:	2430 W SUNKIST RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85755-9711
Country	:	US
Telephone Number	:	520-544-9614
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	ALAN KENNEDY
Credential	:
Telephone Number	:	520-544-9614

Provider Enumeration Date	:	11/17/2008
Last Update Date	:	11/17/2008

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