Alliance Wellness Center LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

1077449 Issued in MN

Legal business name

ALLIANCE WELLNESS CENTER LLC

Practice address

1120 E 80TH St Ste 108
Bloomington, MN 55420-1463

Phone

(952) 992-9803

NPI assigned

Mar 12, 2015

Last updated

Mar 12, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Yussuf Shafie, MSW LGSWNPI 1104276161

Title

Executive Director

Phone

(952) 992-9803

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Yussuf Shafie, MSW LICSW, LADC

  • Addiction (Substance Use Disorder) Counselor
  • Bloomington, MN
  • NPI 1104276161
  Medicare reassignment NPD Authorized official
• Colette Maureen Bisanz-Haas, MA, LADC

  • Addiction (Substance Use Disorder) Counselor
  • Bloomington, MN
  • NPI 1346601804
  NPD (past)
• Gwendolyn Onumah-Onikoro, LICSW

  • Mental Health Counselor
  • Bloomington, MN
  • NPI 1144666090
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1426118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426118400000",
    "number": "1184017279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 E 80TH ST STE 108",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554201463",
            "telephone_number": "952-992-9803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 E 80TH ST STE 108",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554201463",
            "telephone_number": "952-992-9803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIANCE WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-12",
        "last_updated": "2015-03-12",
        "status": "A",
        "authorized_official_last_name": "SHAFIE",
        "authorized_official_first_name": "YUSSUF",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "952-992-9803",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSW  LGSW"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "MN",
            "license": "1077449",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Michelle Allen-Swanson, MD
• Brian Francis Allen, M.D.
• Daniel Allen, DPT
• Tiffany Rose Allen, MA, LMFT
• Alliance Behavioral Care
• Alliance Wellness Clinic Inc.
• Allied Chiropractic Center of Eagan PA.
• Allina Health System (Allina Health Bloomington Clinic)
• Ian Ally
• Almore Medical Services

• Substance Use Disorder Rehabilitation Clinic/Center in Bloomington, MN
• Providers in Bloomington, MN by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.