Provider Demographics
NPI:1104573195
Name:ASPIRE WELLNESS SOLUTIONS LLC
Entity type:Organization
Organization Name:ASPIRE WELLNESS SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ISMAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-442-6011
Mailing Address - Street 1:13209 SHERBURNE AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BECKER
Mailing Address - State:MN
Mailing Address - Zip Code:55308
Mailing Address - Country:US
Mailing Address - Phone:612-227-7170
Mailing Address - Fax:
Practice Address - Street 1:13209 SHERBURNE AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:BECKER
Practice Address - State:MN
Practice Address - Zip Code:55308
Practice Address - Country:US
Practice Address - Phone:612-442-6011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No252Y00000XAgenciesEarly Intervention Provider Agency
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health