Provider Demographics
NPI:1033637673
Name:WELLNESS CENTER
Entity Type:Organization
Organization Name:WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESDIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:MOHAMUD
Authorized Official - Last Name:ADAN
Authorized Official - Suffix:
Authorized Official - Credentials:BSC, MHRT/C
Authorized Official - Phone:207-344-7526
Mailing Address - Street 1:37 PARK STREET, SUITE 305
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240
Mailing Address - Country:US
Mailing Address - Phone:207-755-9042
Mailing Address - Fax:207-755-9041
Practice Address - Street 1:37 PARK STREET, SUITE 305
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-755-9042
Practice Address - Fax:207-755-9041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMHA733306261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health