Provider Demographics
NPI:1003460767
Name:WELLNESS GROUP HOME CORPORATION
Entity Type:Organization
Organization Name:WELLNESS GROUP HOME CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDIRASHID
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-205-6554
Mailing Address - Street 1:2606 64TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2007
Mailing Address - Country:US
Mailing Address - Phone:612-205-6554
Mailing Address - Fax:
Practice Address - Street 1:2606 64TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2007
Practice Address - Country:US
Practice Address - Phone:612-205-6554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)