Provider Demographics
NPI:1023841921
Name:QASS WELLNESS REVOLUTION LLC
Entity type:Organization
Organization Name:QASS WELLNESS REVOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABUDL
Authorized Official - Middle Name:JALEEL
Authorized Official - Last Name:QAZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-464-9616
Mailing Address - Street 1:551 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-6250
Mailing Address - Country:US
Mailing Address - Phone:224-464-9616
Mailing Address - Fax:
Practice Address - Street 1:551 SOUTH ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-6250
Practice Address - Country:US
Practice Address - Phone:224-464-9616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)