Organization
PIONEER HEALING AND RESTORATION SERVICES INC,
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OMAR MOHAMED (CEO)
(612) 636-3593
Entity
Organization
Contact information
Practice address
1885 UNIVERSITY AVE W STE 300A, SAINT PAUL, MN 55104-3462
(612) 564-9554
Mailing address
1885 UNIVERSITY AVE W, SUITE 300A, ST PAUL, MN 55104
(612) 564-9554
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
02/06/2018
Last updated
02/06/2018
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