Provider Demographics
NPI:1083626311
Name:OAKSIDE CORPORATION
Entity Type:Organization
Organization Name:OAKSIDE CORPORATION
Other - Org Name:RIVERSIDE HEALTH EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF RETAIL
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-933-1671
Mailing Address - Street 1:44 MEADOWVIEW CTR
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2041
Mailing Address - Country:US
Mailing Address - Phone:815-933-5187
Mailing Address - Fax:815-935-7486
Practice Address - Street 1:44 MEADOWVIEW CTR
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2041
Practice Address - Country:US
Practice Address - Phone:815-933-5187
Practice Address - Fax:815-935-7486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4670322OtherBLUE CROSS BLUE SHIELD
IL=========-001Medicaid
IL4670322OtherBLUE CROSS BLUE SHIELD