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General NPI Number Information
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NPI Number | 1407847882
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Entity Type | Organization
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Legal Business Name | ACTIVSTYLE LLC
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Dates
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Enumeration Date | 11/03/2005
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 2139 W 95TH ST
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City | CHICAGO
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State | IL
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Zip | 60643-1018
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Country | US
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Telephone | 773-783-4600
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Fax | 773-783-8333
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Provider Business Mailing Address
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Address Line | 1055 WESTGATE DR STE 100
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City | SAINT PAUL
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State | MN
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Zip | 55114-1451
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DARRELL DOUGLAS RAWLINGS
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Credential |
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Telephone | 612-895-7815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 203.001527
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 203000538
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License Number State | IL
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