MEDICARE: KABE THERAPEUTIC SERVICES LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1356012447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KABE THERAPEUTIC SERVICES LLC

Provider Business Mailing Address
First Line	:	962 UNIVERSITY AVE W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-4703
Country	:	US
Telephone Number	:	612-401-1786
Fax Number	:

Provider Business Practice Location Address
First Line	:	962 UNIVERSITY AVE W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-4703
Country	:	US
Telephone Number	:	612-401-1786
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARYAN FARAH
Credential	:
Telephone Number	:	206-817-5522

Provider Enumeration Date	:	09/28/2021
Last Update Date	:	11/24/2021

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