Healthcare Provider Details

I. General information

NPI: 1245831197
Provider Name (Legal Business Name): THE LIFESUPPLIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26117 S COUNTYFAIR DR
MONEE IL
60449-8783
US

IV. Provider business mailing address

26117 S COUNTYFAIR DR
MONEE IL
60449-8783
US

V. Phone/Fax

Practice location:
  • Phone: 708-259-0811
  • Fax: 708-441-2131
Mailing address:
  • Phone: 708-259-0811
  • Fax: 708-441-2131

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 Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: EDITH OGOCHUKWU NWANDU
Title or Position: PRESIDENT
Credential: CEO
Phone: 708-259-0811