| Goodplace Mental Health Services Llc | |
|
600 Twelve Oaks Center Dr Ste 207 Wayzata MN 55391-4535 | |
| (952) 217-0240 | |
| (612) 230-8820 |
| Full Name | Goodplace Mental Health Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 600 Twelve Oaks Center Dr Ste 207, Wayzata, Minnesota |
| Authorized Official Name and Position | Michael Tochukwu Nwanna (OWNER/CEO) |
| Authorized Official Contact | 9522170240 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Goodplace Mental Health Services Llc 10343 41st Pl Ne Saint Michael MN 55376-3045 Ph: (952) 217-0240 | Goodplace Mental Health Services Llc 600 Twelve Oaks Center Dr Ste 207 Wayzata MN 55391-4535 Ph: (952) 217-0240 |
| NPI Number | 1003631730 |
|---|---|
| Provider Enumeration Date | 11/18/2024 |
| Last Update Date | 12/18/2024 |
| Certification Date | 12/18/2024 |
| Medicare PECOS PAC ID | 0749717221 |
|---|---|
| Medicare Enrollment ID | O20241223000078 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003631730 | NPI | - | NPPES |
| Provider Name | Michael T Nwanna |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942047550 PECOS PAC ID: 7315472107 Enrollment ID: I20241203002971 |
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