Provider Demographics
NPI:1073392676
Name:CUMI WELLNESS
Entity Type:Organization
Organization Name:CUMI WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:CAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-607-8544
Mailing Address - Street 1:1340 HAZEL ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-4506
Mailing Address - Country:US
Mailing Address - Phone:763-607-8544
Mailing Address - Fax:
Practice Address - Street 1:1340 HAZEL ST N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-4506
Practice Address - Country:US
Practice Address - Phone:763-607-8544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health