Healthcare Provider Details

I. General information

NPI: 1033637673
Provider Name (Legal Business Name): WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 PARK STREET, SUITE 305
LEWISTON ME
04240
US

IV. Provider business mailing address

37 PARK STREET, SUITE 305
LEWISTON ME
04240
US

V. Phone/Fax

Practice location:
  • Phone: 207-755-9042
  • Fax: 207-755-9041
Mailing address:
  • Phone: 207-755-9042
  • Fax: 207-755-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMHA733306
License Number StateME

VIII. Authorized Official

Name: HASSAN MOHAMUD ADAN
Title or Position: PRESDIDENT/CEO
Credential: B.SC, MHRT/C
Phone: 207-344-7526