Organization
PROVISION WELLNESS CENTER LLC
Active
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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