Provider Demographics
NPI:1952311128
Name:THERA-TECH EQUIPMENT
Entity Type:Organization
Organization Name:THERA-TECH EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHALRES
Authorized Official - Middle Name:
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-718-0200
Mailing Address - Street 1:PO BOX 60
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-0060
Mailing Address - Country:US
Mailing Address - Phone:630-351-3333
Mailing Address - Fax:630-307-7306
Practice Address - Street 1:106 3RD ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2953
Practice Address - Country:US
Practice Address - Phone:630-351-3333
Practice Address - Fax:630-307-7306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02219496OtherBLUE CROSS / BLUE SHIELD
IL02219496OtherBLUE CROSS / BLUE SHIELD