Provider Demographics
NPI:1528305984
Name:VILLAGE WELLNESS CENTER INC.
Entity type:Organization
Organization Name:VILLAGE WELLNESS CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABDIRIZAK
Authorized Official - Middle Name:B
Authorized Official - Last Name:ABDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-269-2760
Mailing Address - Street 1:1380 ENERGY LN STE 207
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-5352
Mailing Address - Country:US
Mailing Address - Phone:651-330-3653
Mailing Address - Fax:651-340-6107
Practice Address - Street 1:1380 ENERGY LN STE 207
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-5352
Practice Address - Country:US
Practice Address - Phone:651-269-2760
Practice Address - Fax:651-340-6107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-05
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health