Provider Demographics
NPI:1588557342
Name:LOOM WELLNESS CENTER LLC
Entity type:Organization
Organization Name:LOOM WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HODAN
Authorized Official - Middle Name:IBRAHIM
Authorized Official - Last Name:YUSUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-407-1769
Mailing Address - Street 1:1000 E 146TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4655
Mailing Address - Country:US
Mailing Address - Phone:612-407-1769
Mailing Address - Fax:
Practice Address - Street 1:1000 E 146TH ST STE 105
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4655
Practice Address - Country:US
Practice Address - Phone:612-407-1769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency