| Provision Wellness Center Llc | |
|
4001 Stinson Blvd Suite 300 St. Anthony MN 55421-3488 | |
| (612) 401-1786 | |
| Not Available |
| Full Name | Provision Wellness Center Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 4001 Stinson Blvd, St. Anthony, Minnesota |
| Authorized Official Name and Position | Maryan Farah (OWNER) |
| Authorized Official Contact | 6124011786 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Provision Wellness Center Llc 4001 Stinson Blvd Ne Ste 300 Minneapolis MN 55421-3424 Ph: (612) 401-1786 | Provision Wellness Center Llc 4001 Stinson Blvd Suite 300 St. Anthony MN 55421-3488 Ph: (612) 401-1786 |
| NPI Number | 1427611318 |
|---|---|
| Provider Enumeration Date | 04/17/2019 |
| Last Update Date | 04/02/2026 |
| Certification Date | 04/02/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427611318 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
Shining Light Skill Building Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3055 Old Highway 8 Ste 106b, St. Anthony, MN 55418 Phone: 612-978-0760 |