Provider Demographics
NPI:1346096047
Name:THE WELLNESS CLINIC L.L.C.
Entity type:Organization
Organization Name:THE WELLNESS CLINIC L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FAYSEL
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-354-5895
Mailing Address - Street 1:317 CENTRAL AVE N STE 5
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5214
Mailing Address - Country:US
Mailing Address - Phone:651-354-5895
Mailing Address - Fax:
Practice Address - Street 1:317 CENTRAL AVE N STE 5
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5214
Practice Address - Country:US
Practice Address - Phone:651-354-5895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health