Provider Demographics
NPI:1740387513
Name:KALKAAL HOME CARE, INC
Entity Type:Organization
Organization Name:KALKAAL HOME CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MNAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDIWAHAB
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:YUSUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-333-1690
Mailing Address - Street 1:1929 S. 5TH ST.
Mailing Address - Street 2:STE. 100
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-8801
Mailing Address - Country:US
Mailing Address - Phone:612-333-1690
Mailing Address - Fax:612-333-1503
Practice Address - Street 1:1929 S. 5TH ST.
Practice Address - Street 2:STE. 100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-8801
Practice Address - Country:US
Practice Address - Phone:612-333-1690
Practice Address - Fax:612-333-1503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN752166900Medicaid