Healthcare Provider Details

I. General information

NPI: 1689642969
Provider Name (Legal Business Name): CHESAPEAKE REHAB EQUIPMENT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 09/21/2024
Certification Date: 09/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CARSON DR. SUITE 206
BEAR DE
19701
US

IV. Provider business mailing address

805 BROOK ST STE 402
ROCKY HILL CT
06067-3431
US

V. Phone/Fax

Practice location:
  • Phone: 302-266-6234
  • Fax: 302-266-6232
Mailing address:
  • Phone: 314-447-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number1997119307
License Number StateDE

VIII. Authorized Official

Name: TAMAS JOHNSON
Title or Position: CFO
Credential:
Phone: 314-447-7515