Crystal Wellness Center LLC
Clinic/Center, Adult Mental Health in Bloomington, MN. Organization (NPI-2).
NPI number1194359547
StatusActive
Last updated in NPPESJul 17, 2024
Details
- NPI
- 1194359547
- Entity type
- Organization (NPI-2)
- Legal business name
- Crystal Wellness Center LLC
- Organization subpart
- No
- Enumeration date
- Feb 25, 2020
- Certification date
- Jul 17, 2024
- Last updated
- Jul 17, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0850X | Clinic/Center, Adult Mental Health | – | – | Yes |
| 261Q00000X | Clinic/Center | – | – | |
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | |
| 261QM0855X | Clinic/Center, Adolescent and Children Mental Health | – | – |
Practice location
9001 E Bloomington Fwy Ste 147Bloomington, MN 55420-3450
Phone 952-658-6845
Mailing address
9001 E Bloomington Fwy Ste 147Bloomington, MN 55420-3450
Phone 952-658-6845 · Fax 612-295-0381
Authorized official
Ahmedweli Farah
Owner/Administrator
9526586845
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