Healthcare Provider Details

I. General information

NPI: 1447181052
Provider Name (Legal Business Name): COREVISTA ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4659 SQUAW VALLEY DR
LOVES PARK IL
61111-5395
US

IV. Provider business mailing address

4659 SQUAW VALLEY DR
LOVES PARK IL
61111-5395
US

V. Phone/Fax

Practice location:
  • Phone: 603-999-0748
  • Fax:
Mailing address:
  • Phone: 603-999-0748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SAAD FEROZ
Title or Position: CEO
Credential: MD
Phone: 603-999-0748