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General NPI Number Information
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NPI Number | 1629930102
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Entity Type | Organization
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Legal Business Name | ADVANCE HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 415 CONGRESS ST STE 301O
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City | PORTLAND
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State | ME
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Zip | 04101-3586
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Country | US
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Telephone | 612-236-6763
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Fax |
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Provider Business Mailing Address
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Address Line | 5135 161ST ST W APT 2103
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City | LAKEVILLE
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State | MN
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Zip | 55044-8814
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Country | US
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Telephone | 612-236-6763
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | OSMAN MOHAMED
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Credential |
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Telephone | 619-808-4999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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