Healthcare Provider Details

I. General information

NPI: 1407847882
Provider Name (Legal Business Name): ACTIVSTYLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date: 12/28/2012
Reactivation Date: 03/05/2013

III. Provider practice location address

2139 W 95TH ST
CHICAGO IL
60643-1018
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number203000538
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number203.001527
License Number StateIL

VIII. Authorized Official

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