Provider Demographics
NPI:1356366140
Name:DENSON SHOPS INC
Entity type:Organization
Organization Name:DENSON SHOPS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-665-1488
Mailing Address - Street 1:P O BOX 703
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-0703
Mailing Address - Country:US
Mailing Address - Phone:630-665-1488
Mailing Address - Fax:630-668-1396
Practice Address - Street 1:509 S CARLTON AVE
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-0703
Practice Address - Country:US
Practice Address - Phone:630-665-1488
Practice Address - Fax:630-668-1396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203.000494332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========003Medicaid
IL0229650003Medicare NSC