Provision Wellness Center LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

PROVISION WELLNESS CENTER LLC

Doing business as

Provision Wellness Center LLC

Practice address

4001 Stinson Blvd
Suite 300
St. Anthony, MN 55421-3488

Phone

(612) 401-1786

NPI assigned

Apr 17, 2019

Organization subpart

No

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

Authorized official

Name

Maryan Farah

Title

Owner

Phone

(612) 401-1786

Specialties & licenses 1

Addresses

Other names 1

• Provision Wellness Center LLC Doing business as

Locations

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

{
    "created_epoch": "1555459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775088000000",
    "number": "1427611318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4001 STINSON BLVD NE STE 300",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554213424",
            "telephone_number": "612-401-1786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 STINSON BLVD",
            "address_2": "SUITE 300",
            "city": "ST. ANTHONY",
            "state": "MN",
            "postal_code": "554213488",
            "telephone_number": "612-401-1786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVISION WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-17",
        "last_updated": "2026-04-02",
        "certification_date": "2026-04-02",
        "status": "A",
        "authorized_official_last_name": "FARAH",
        "authorized_official_first_name": "MARYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-401-1786"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Provision Wellness Center LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Allyson Plumberg, M.S.CCC-SLP
• Premier Health Homes Inc
• Priority Health Center
• Priority Transport LLC
• Provident Home Healthcare, LLC
• Amal Hassan Qassim
• Abdullahi Rage
• Elizabeth Georgeanne Raivo-Lynch, IBCLC
• Abdiaziz Rashid
• Deeqo Hassan Rooble

• Adult Mental Health Clinic/Center in St. Anthony, MN
• Providers in St. Anthony, MN by specialty
• Adult Mental Health Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.