=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770753659
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REST ASSURED HOME MEDICAL EQUIPMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2008
-----------------------------------------------------
Last Update Date | 09/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2201 S HALSTED ST STE. 1252
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60608-4585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-226-9989
-----------------------------------------------------
Fax | 312-997-9985
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2201 S HALSTED ST STE. 1252
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60608-4585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-226-9989
-----------------------------------------------------
Fax | 312-997-9985
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | GREGORY WOOD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 312-226-9989
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 203.000989
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------