Provider Demographics
NPI:1780883348
Name:KEBBEH, MARY SUE
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:SUE
Last Name:KEBBEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 SLEEPY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6010
Mailing Address - Country:US
Mailing Address - Phone:214-951-0800
Mailing Address - Fax:214-819-3862
Practice Address - Street 1:1234 SLEEPY HOLLOW DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-6010
Practice Address - Country:US
Practice Address - Phone:214-951-0800
Practice Address - Fax:214-819-3862
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility