Provider Demographics
NPI:1598282899
Name:HEALING CENTER LLC
Entity Type:Organization
Organization Name:HEALING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:ELMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LGSW
Authorized Official - Phone:218-248-0598
Mailing Address - Street 1:226 WYANDOTTE RD
Mailing Address - Street 2:
Mailing Address - City:HOYT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55750-1226
Mailing Address - Country:US
Mailing Address - Phone:218-248-0598
Mailing Address - Fax:
Practice Address - Street 1:226 WYANDOTTE RD
Practice Address - Street 2:
Practice Address - City:HOYT LAKES
Practice Address - State:MN
Practice Address - Zip Code:55750-1226
Practice Address - Country:US
Practice Address - Phone:218-248-0598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25870104100000X
MN122471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1699861229Medicaid