Provider Demographics
NPI:1235965542
Name:ATLAS WELLNESS L. L. C.
Entity type:Organization
Organization Name:ATLAS WELLNESS L. L. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ISMAHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-649-2465
Mailing Address - Street 1:6817 MANCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-6701
Mailing Address - Country:US
Mailing Address - Phone:952-649-2465
Mailing Address - Fax:
Practice Address - Street 1:1710 DOUGLAS DR N # 255C
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4327
Practice Address - Country:US
Practice Address - Phone:952-649-2465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health