Healthcare Provider Details

I. General information

NPI: 1942509526
Provider Name (Legal Business Name): MAINSTREET ACCESSIBILITY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8695 SOUTH ARCHER AVE UNIT 7
WILLOW SPRINGS IL
60480
US

IV. Provider business mailing address

211 WEBSTER ST
MONTGOMERY IL
60538-1323
US

V. Phone/Fax

Practice location:
  • Phone: 630-401-1161
  • Fax:
Mailing address:
  • Phone: 630-401-1161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL A LANIOSZ
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 630-401-1161