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General NPI Number Information
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NPI Number | 1760476618
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Entity Type | Organization
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Legal Business Name | REHABILITATIVE PRODUCTS & NUTRITIONAL SUPPLY,INC.
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Dates
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Enumeration Date | 09/07/2005
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Last Update Date | 08/22/2008
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Provider Practice Location Address
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Address Line | 11736 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643-4732
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Country | US
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Telephone | 773-445-7482
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Fax | 773-445-7522
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Provider Business Mailing Address
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Address Line | 11736 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643-4732
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Country | US
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Telephone | 773-445-7482
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Fax | 773-445-7522
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. KEITH D. CARTER
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Credential |
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Telephone | 773-445-7470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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