Provider Demographics
NPI:1689664781
Name:EASY LIVING COMFORT STORE, INC.
Entity Type:Organization
Organization Name:EASY LIVING COMFORT STORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HILL-DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-301-6589
Mailing Address - Street 1:13007 W 143RD ST
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8315
Mailing Address - Country:US
Mailing Address - Phone:708-301-6589
Mailing Address - Fax:708-301-8704
Practice Address - Street 1:13007 W 143RD ST
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-8315
Practice Address - Country:US
Practice Address - Phone:708-301-6589
Practice Address - Fax:708-301-8704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2020-08-22
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
IL5507740001Medicare NSC