Provider Demographics
NPI:1821350661
Name:KBR, INC.
Entity Type:Organization
Organization Name:KBR, INC.
Other - Org Name:HOME INSTEAD SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:REPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-796-6393
Mailing Address - Street 1:2340 PASEO DEL PRADO
Mailing Address - Street 2:SUITE D112
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-4360
Mailing Address - Country:US
Mailing Address - Phone:702-796-6393
Mailing Address - Fax:702-796-6392
Practice Address - Street 1:2340 PASEO DEL PRADO
Practice Address - Street 2:SUITE D112
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4360
Practice Address - Country:US
Practice Address - Phone:702-796-6393
Practice Address - Fax:702-796-6392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5443PCS-2253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care