Provider Demographics
NPI:1336361781
Name:CELESTIAL HOME MEDICAL SUPPLY AND EQUIPMENT CORPORATION
Entity Type:Organization
Organization Name:CELESTIAL HOME MEDICAL SUPPLY AND EQUIPMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFRIES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-531-7392
Mailing Address - Street 1:9449 S KEDZIE AVE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2325
Mailing Address - Country:US
Mailing Address - Phone:773-531-7392
Mailing Address - Fax:773-363-3621
Practice Address - Street 1:9449 S KEDZIE AVE
Practice Address - Street 2:SUITE 213
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2325
Practice Address - Country:US
Practice Address - Phone:773-531-7392
Practice Address - Fax:773-363-3621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies