Organization
CRYSTAL WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AHMEDWELI FARAH (OWNER/ADMINISTRATOR)
(952) 658-6845
Entity
Organization
Contact information
Practice address
9001 E BLOOMINGTON FWY STE 147, BLOOMINGTON, MN 55420-3450
(952) 658-6845
Mailing address
9001 E BLOOMINGTON FWY STE 147, BLOOMINGTON, MN 55420-3450
(952) 658-6845
(612) 295-0381
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
02/25/2020
Last updated
07/17/2024
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