Provider Demographics
NPI:1992012207
Name:WELIA HEALTH
Entity Type:Organization
Organization Name:WELIA HEALTH
Other - Org Name:WELIA HEALTH PINE CITY
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ULSETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-679-1212
Mailing Address - Street 1:301 HIGHWAY 65 S
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:MN
Mailing Address - Zip Code:55051-1899
Mailing Address - Country:US
Mailing Address - Phone:320-679-1212
Mailing Address - Fax:320-225-3345
Practice Address - Street 1:1425 MAIN STREET NORTH
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-1530
Practice Address - Country:US
Practice Address - Phone:320-629-7505
Practice Address - Fax:320-629-2202
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELIA HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-08
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261QR1300X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN24-3462Medicare PIN
MN24-3462Medicare PIN