MEDICARE: KALEB, INC.

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	339768	MN

General Provider Information

NPI Number	:	1083866859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KALEB, INC.

Provider Business Mailing Address
First Line	:	869 MENDAKOTA CT
Second Line	:
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55120-1336
Country	:	US
Telephone Number	:	651-905-9908
Fax Number	:

Provider Business Practice Location Address
First Line	:	869 MENDAKOTA CT
Second Line	:
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55120-1336
Country	:	US
Telephone Number	:	651-905-9908
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEVEN J. WEINTRAUT
Credential	:
Telephone Number	:	612-337-6124

Provider Enumeration Date	:	10/10/2008
Last Update Date	:	10/10/2008

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