=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508607656
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELCARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2024
-----------------------------------------------------
Last Update Date | 06/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2626 E 82ND ST STE 215
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55425-1381
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-427-4938
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2626 E 82ND ST STE 215
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55425-1381
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-427-4938
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MOHAMED YUSUF MOHAMED
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 612-427-4938
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------