MEDICARE: WEBER HOME CARE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1730938820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEBER HOME CARE LLC

Provider Business Mailing Address
First Line	:	4445 77TH ST W STE 121
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-5134
Country	:	US
Telephone Number	:	612-500-7832
Fax Number	:

Provider Business Practice Location Address
First Line	:	4445 77TH ST W STE 121
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-5134
Country	:	US
Telephone Number	:	612-500-7832
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NICHOLAS WEBER
Credential	:
Telephone Number	:	612-500-7832

Provider Enumeration Date	:	05/13/2024
Last Update Date	:	05/13/2024

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