MEDICARE: STATIS WELLNESS L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1114748290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATIS WELLNESS L.L.C.

Provider Business Mailing Address
First Line	:	1615 EDGEMONT ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55130-4632
Country	:	US
Telephone Number	:	207-518-3425
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 EDGEMONT ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55130-4632
Country	:	US
Telephone Number	:	207-518-3425
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ABDI HASSAN
Credential	:
Telephone Number	:	207-518-3425

Provider Enumeration Date	:	10/21/2024
Last Update Date	:	10/21/2024

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