MEDICARE: WELLNESS WAYS HEALTH, INC

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	:	1679267744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS WAYS HEALTH, INC

Provider Business Mailing Address
First Line	:	2647 BLOOMINGTON AVE UNIT 1
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1187
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2647 BLOOMINGTON AVE UNIT 1
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1187
Country	:	US
Telephone Number	:	612-913-2439
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SADIA DIRIYE
Credential	:
Telephone Number	:	612-913-2439

Provider Enumeration Date	:	06/02/2023
Last Update Date	:	06/02/2023

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