Provider Demographics
NPI:1790163251
Name:KEBROS & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:KEBROS & ASSOCIATES, LLC
Other - Org Name:SMARTCARE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ABIMBOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:EBODA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-419-5343
Mailing Address - Street 1:1604 SPRING HILL RD
Mailing Address - Street 2:SUITE# 300
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22185-7510
Mailing Address - Country:US
Mailing Address - Phone:800-419-5343
Mailing Address - Fax:240-455-4313
Practice Address - Street 1:1604 SPRING HILL RD
Practice Address - Street 2:SUITE# 300
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-7510
Practice Address - Country:US
Practice Address - Phone:800-419-5343
Practice Address - Fax:240-455-4313
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEBROS & ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based