Provider Demographics
NPI:1285826560
Name:SPECIALTY WHEELCHAIR, INC.
Entity Type:Organization
Organization Name:SPECIALTY WHEELCHAIR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:N
Authorized Official - Last Name:ODARCZENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-202-4660
Mailing Address - Street 1:742 E. NORTHWEST HWY.
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074
Mailing Address - Country:US
Mailing Address - Phone:847-202-4660
Mailing Address - Fax:847-202-4681
Practice Address - Street 1:742 E NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-6353
Practice Address - Country:US
Practice Address - Phone:847-202-4660
Practice Address - Fax:847-202-4681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202885030001OtherPUBLICAID
IL202885030001OtherPUBLICAID