Provider Demographics
NPI:1972319739
Name:POSITVE CHANGE WELLNESS LLC
Entity type:Organization
Organization Name:POSITVE CHANGE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABADIR
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-978-8510
Mailing Address - Street 1:1005 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3833
Mailing Address - Country:US
Mailing Address - Phone:612-978-8510
Mailing Address - Fax:
Practice Address - Street 1:1005 E 24TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3833
Practice Address - Country:US
Practice Address - Phone:612-978-8510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty