Healthcare Provider Details

I. General information

NPI: 1164775664
Provider Name (Legal Business Name): ACTIVSTYLE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9245 S ASHLAND AVE
CHICAGO IL
60620-5051
US

IV. Provider business mailing address

1055 WESTGATE DR STE 100
SAINT PAUL MN
55114-1451
US

V. Phone/Fax

Practice location:
  • Phone: 773-783-4600
  • Fax: 773-783-8333
Mailing address:
  • Phone: 888-280-8632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: DARRELL DOUGLAS RAWLINGS
Title or Position: CEO
Credential:
Phone: 612-895-7815