Provider Demographics
NPI:1770753659
Name:REST ASSURED HOME MEDICAL EQUIPMENT
Entity type:Organization
Organization Name:REST ASSURED HOME MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-226-9989
Mailing Address - Street 1:2201 S HALSTED ST
Mailing Address - Street 2:STE. 1252
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-4585
Mailing Address - Country:US
Mailing Address - Phone:312-226-9989
Mailing Address - Fax:312-997-9985
Practice Address - Street 1:2201 S HALSTED ST
Practice Address - Street 2:STE. 1252
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-4585
Practice Address - Country:US
Practice Address - Phone:312-226-9989
Practice Address - Fax:312-997-9985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203.000989332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6175160001Medicare NSC