Healthcare Provider Details

I. General information

NPI: 1578255675
Provider Name (Legal Business Name): SOLSTICE IMAGING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 N YORK ST # A
ELMHURST IL
60126-1604
US

IV. Provider business mailing address

915 N YORK ST APT 603
ELMHURST IL
60126-1256
US

V. Phone/Fax

Practice location:
  • Phone: 630-530-0112
  • Fax: 312-501-0012
Mailing address:
  • Phone: 312-520-8824
  • Fax: 630-501-0012

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 Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: SUNSHINE JONES BALLENTINE
Title or Position: PRESIDENT
Credential: MA, LPC
Phone: 312-520-8824