Healthcare Provider Details

I. General information

NPI: 1235048026
Provider Name (Legal Business Name): IMPERIUM RESERVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 CRYSTAL ROCK RD
NAPERVILLE IL
60564-8236
US

IV. Provider business mailing address

3060 CRYSTAL ROCK RD
NAPERVILLE IL
60564-8236
US

V. Phone/Fax

Practice location:
  • Phone: 123-456-7890
  • Fax:
Mailing address:
  • Phone: 618-500-3334
  • 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: SAADAIN WAHAB
Title or Position: OWNER
Credential:
Phone: 618-500-3334