Provider Demographics
NPI:1629930102
Name:ADVANCE HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:ADVANCE HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OSMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-808-4999
Mailing Address - Street 1:5135 161ST ST W APT 2103
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-8814
Mailing Address - Country:US
Mailing Address - Phone:612-236-6763
Mailing Address - Fax:
Practice Address - Street 1:415 CONGRESS ST STE 301O
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3586
Practice Address - Country:US
Practice Address - Phone:612-236-6763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-02
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care