Organization
REVIVE WELLNESS CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANWAR MUSTAFA ABUKAR (PRESIDENT)
(612) 707-6834
Entity
Organization
Contact information
Practice address
2704 14TH AVE S, MINNEAPOLIS, MN 55407-1127
(612) 987-2990
(612) 987-2990
Mailing address
2704 14TH AVE S, MINNEAPOLIS, MN 55407-1127
(612) 987-2990
(612) 987-2990
Taxonomy
Speciality
Code
Description
License number
State
261QR0800X
Recovery Care Clinic/Center
Primary
—
—
Other
Enumeration date
03/15/2025
Last updated
03/15/2025
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