Provider Demographics
NPI:1558385112
Name:R & R MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:R & R MEDICAL SUPPLY, INC.
Other - Org Name:FAIR HAVEN MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-566-5801
Mailing Address - Street 1:608 E. HAWLEY ST.
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-1945
Mailing Address - Country:US
Mailing Address - Phone:847-566-5801
Mailing Address - Fax:847-566-5803
Practice Address - Street 1:608 E. HAWLEY ST.
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-1945
Practice Address - Country:US
Practice Address - Phone:847-566-5801
Practice Address - Fax:847-566-5803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000604332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid