Provider Demographics
NPI:1760531834
Name:CAIN DURABLE MED EQUIP
Entity Type:Organization
Organization Name:CAIN DURABLE MED EQUIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-865-6393
Mailing Address - Street 1:4135 W 194TH CT
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-5841
Mailing Address - Country:US
Mailing Address - Phone:708-365-6393
Mailing Address - Fax:708-365-6394
Practice Address - Street 1:4135 W 194TH CT
Practice Address - Street 2:
Practice Address - City:COUNTRY CLUB HILLS
Practice Address - State:IL
Practice Address - Zip Code:60478-5841
Practice Address - Country:US
Practice Address - Phone:708-365-6393
Practice Address - Fax:708-365-6394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200539110Medicaid
IN=========0001Medicaid
IL=========0001Medicaid
IL5633480001Medicare NSC
IN=========0001Medicaid