Healthcare Provider Details

I. General information

NPI: 1255108858
Provider Name (Legal Business Name): CATINA A CHARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25748 W SUNNYMERE DR
PLAINFIELD IL
60585-1461
US

IV. Provider business mailing address

25748 W SUNNYMERE DR
PLAINFIELD IL
60585-1461
US

V. Phone/Fax

Practice location:
  • Phone: 888-206-1757
  • Fax:
Mailing address:
  • Phone: 888-206-1757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: