MEDICARE: LBO 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	253Z00000X	In Home Supportive Care Agency	7549PCS-0	NV

General Provider Information

NPI Number	:	1922340561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LBO LLC

Provider Business Mailing Address
First Line	:	6280 S VALLEY VIEW BLVD
Second Line	:	SUITE 721
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3809
Country	:	US
Telephone Number	:	888-226-8068
Fax Number	:	888-881-0459

Provider Business Practice Location Address
First Line	:	6280 S VALLEY VIEW BLVD
Second Line	:	SUITE 721
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3809
Country	:	US
Telephone Number	:	888-226-8068
Fax Number	:	888-881-0459

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	RHYS LIM
Credential	:
Telephone Number	:	888-226-8068

Provider Enumeration Date	:	03/21/2013
Last Update Date	:	01/30/2014

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Directions to “LBO LLC ” Practice Location

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