NPIMap

Organization Active NPI

Premier Wellness Inc

  • Assisted Living Facility
  • Minneapolis, MN
National Provider Identifier
1710586649
Registry record updated Jul 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
PREMIER WELLNESS INC
Practice address
2909 Hennepin Ave S., Ste 200
Minneapolis, MN 55408
Phone
(612) 598-4120
NPI assigned
Oct 21, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2021

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

Authorized official

Name
Yussuf Omar Abdi
Title
Director
Phone
(612) 598-4120

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Community/Behavioral Health Agency 251S00000X
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

2909 Hennepin Ave S., Ste 200
Minneapolis, MN 55408

Mailing address

1422 W Lake St Ste 213
Minneapolis, MN 55408-2616
Phone (612) 223-6744

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1603238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627430400000",
    "number": "1710586649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1422 W LAKE ST STE 213",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554082616",
            "telephone_number": "612-223-6744",
            "fax_number": "612-223-6773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2909 HENNEPIN AVE S., STE 200",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55408",
            "telephone_number": "612-598-4120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER WELLNESS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-21",
        "last_updated": "2021-07-28",
        "certification_date": "2021-07-28",
        "status": "A",
        "authorized_official_last_name": "ABDI",
        "authorized_official_first_name": "YUSSUF",
        "authorized_official_middle_name": "OMAR",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "612-598-4120"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2021; 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.