Provider Demographics
NPI:1932667516
Name:ABC HOME MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:ABC HOME MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:M
Authorized Official - Last Name:VESTAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-897-8588
Mailing Address - Street 1:PO BOX 674553
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-4553
Mailing Address - Country:US
Mailing Address - Phone:866-897-8588
Mailing Address - Fax:772-212-4904
Practice Address - Street 1:651 W TERRA COTTA AVE STE 221
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3401
Practice Address - Country:US
Practice Address - Phone:779-220-0075
Practice Address - Fax:877-785-7396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILTBDMedicaid