Provider Demographics
NPI:1467171520
Name:KEILIYAH MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:KEILIYAH MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SERAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KABBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-863-6517
Mailing Address - Street 1:6381 LITTLE RIVER TPKE STE 4
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-5002
Mailing Address - Country:US
Mailing Address - Phone:703-863-6517
Mailing Address - Fax:
Practice Address - Street 1:6381 LITTLE RIVER TPKE STE 4
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-5002
Practice Address - Country:US
Practice Address - Phone:703-863-6517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies