Organization
MINNEOSTA WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. UBAH ABUBAKER SHIRWA (OWNER)
(612) 618-5841
Entity
Organization
Contact information
Practice address
808 BERRY ST APT 192, SAINT PAUL, MN 55114-1082
(612) 618-5841
(651) 646-0950
Mailing address
808 BERRY ST APT 192, SAINT PAUL, MN 55114-1082
(612) 618-5841
(651) 646-0950
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
1083995-1-HCBS
MN
305S00000X
Point of Service
Primary
1083995-1-HCBS
MN
Other
Enumeration date
01/02/2017
Last updated
01/02/2017
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