Healthcare Provider Details

I. General information

NPI: 1871119966
Provider Name (Legal Business Name): NIMBLE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28369 DAVIS PKWY STE 403
WARRENVILLE IL
60555-3036
US

IV. Provider business mailing address

876 HEATHERFIELD CIR
NAPERVILLE IL
60565-2098
US

V. Phone/Fax

Practice location:
  • Phone: 215-834-7930
  • Fax:
Mailing address:
  • Phone: 215-834-7930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: RAKESH VEDAVYAS
Title or Position: PRESIDENT
Credential:
Phone: 215-834-7930