Organization
WELLNESS GROUP HOME
Active
Organization
WELLNESS GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABDIRIZAK ALI (OWNER)
(612) 298-9447
Entity
Organization
Contact information
Practice address
2109 NICOLLET AVE STE 101, MINNEAPOLIS, MN 55404-3279
(612) 298-9447
Mailing address
2109 NICOLLET AVE STE 101, MINNEAPOLIS, MN 55404-3279
(612) 298-9447
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
311500000X
Alzheimer Center (Dementia Center)
—
—
311ZA0620X
Adult Care Home Facility
—
—
320700000X
Physical Disabilities Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
11/07/2014
Last updated
11/07/2014
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