Organization
PROVISION WELLNESS CENTER LLC
Active
Other names
Provision Wellness Center LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MARYAN FARAH (OWNER)
(612) 401-1786
Entity
Organization
Contact information
Practice address
4001 STINSON BLVD, SUITE 300, ST. ANTHONY, MN 55421-3488
(612) 401-1786
Mailing address
4001 STINSON BLVD NE STE 300, MINNEAPOLIS, MN 55421-3424
(612) 401-1786
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
04/17/2019
Last updated
04/02/2026
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