Provider Demographics
NPI:1376378059
Name:AQUAD WELLNESS GROUP LLC
Entity type:Organization
Organization Name:AQUAD WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDIWELI
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:ELMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-669-3904
Mailing Address - Street 1:10805 173RD ST W APT 228
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-5341
Mailing Address - Country:US
Mailing Address - Phone:612-669-3904
Mailing Address - Fax:
Practice Address - Street 1:6482 BARCLAY AVE
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55077-2165
Practice Address - Country:US
Practice Address - Phone:612-669-3904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-03
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center