NPIMap

Organization Active NPI

Wise Wellness Center LLC

  • Clinic/Center
  • Moorhead, MN
National Provider Identifier
1649033705
Registry record updated Feb 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
WISE WELLNESS CENTER LLC
Practice address
1132 28TH Ave S Ste 101a
Moorhead, MN 56560-4420
Phone
(612) 443-9032
NPI assigned
Feb 1, 2024
Last updated
Feb 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2024

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

Authorized official

Name
Cani Adan
Title
Owner
Phone
(612) 443-9032

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

1132 28TH Ave S Ste 101a
Moorhead, MN 56560-4420

Mailing address

1132 28TH Ave S Ste 101a
Moorhead, MN 56560-4420

National Provider Directory

National Provider Directory

Locations

1132 28th Ave S
Ste 101A
Moorhead, MN 56560
Phone (612) 443-9032

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1706745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706745600000",
    "number": "1649033705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1132 28TH AVE S STE 101A",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565604420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1132 28TH AVE S STE 101A",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565604420",
            "telephone_number": "612-443-9032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISE WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-01",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A",
        "authorized_official_last_name": "ADAN",
        "authorized_official_first_name": "CANI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-443-9032"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moorhead, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2024; 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.