Provider Demographics
NPI:1598581118
Name:AQUA WELLNESS LLC
Entity type:Organization
Organization Name:AQUA WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMUD
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-323-9387
Mailing Address - Street 1:8200 HUMBOLDT AVE S APT 318
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-2261
Mailing Address - Country:US
Mailing Address - Phone:612-323-9387
Mailing Address - Fax:
Practice Address - Street 1:8200 HUMBOLDT AVE S APT 318
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-2261
Practice Address - Country:US
Practice Address - Phone:612-323-9387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty