Provider Demographics
NPI:1689642969
Name:CHESAPEAKE REHAB EQUIPMENT INC.
Entity Type:Organization
Organization Name:CHESAPEAKE REHAB EQUIPMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING AND LICENSURE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-447-7515
Mailing Address - Street 1:805 BROOK ST STE 402
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3431
Mailing Address - Country:US
Mailing Address - Phone:314-447-7500
Mailing Address - Fax:
Practice Address - Street 1:227 LAKE DRIVE
Practice Address - Street 2:PENCADER CORPORATE CENTER
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-3320
Practice Address - Country:US
Practice Address - Phone:302-266-6234
Practice Address - Fax:302-266-6232
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHESAPEAKE REHAB EQUIPMENT INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-10
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171WH0202X, 332B00000X
DE1997119307332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0089915Medicaid
MD233878504Medicaid
DE1689642969Medicaid
PA1007514300026Medicaid
MD233878504Medicaid