Provider Demographics
NPI:1184815755
Name:MAKALU, INC
Entity Type:Organization
Organization Name:MAKALU, INC
Other - Org Name:FRESH START
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-388-4691
Mailing Address - Street 1:1610 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-1650
Mailing Address - Country:US
Mailing Address - Phone:218-724-2945
Mailing Address - Fax:218-724-0699
Practice Address - Street 1:1610 E 1ST ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-1650
Practice Address - Country:US
Practice Address - Phone:218-724-2945
Practice Address - Fax:218-724-0699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness