Provider Demographics
NPI:1568815603
Name:HOPE WELLNESS CENTER CORP
Entity Type:Organization
Organization Name:HOPE WELLNESS CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-319-4759
Mailing Address - Street 1:1821 UNIVERSITY AVE W STE S106
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2810
Mailing Address - Country:US
Mailing Address - Phone:507-319-4759
Mailing Address - Fax:186-659-7095
Practice Address - Street 1:1500 1ST AVE NE STE 111F
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906
Practice Address - Country:US
Practice Address - Phone:320-455-3566
Practice Address - Fax:866-597-0950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1568815603Medicaid