1407905565 NPI number — TRUE CARE DURABLE MEDICAL EQUIPMENT INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407905565 NPI number — TRUE CARE DURABLE MEDICAL EQUIPMENT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRUE CARE DURABLE MEDICAL EQUIPMENT INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407905565
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 315
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MATTESON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60443-0315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-225-1541
Provider Business Mailing Address Fax Number:
877-747-2293

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17135 WESTVIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH HOLLAND
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60473-2755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-747-2253
Provider Business Practice Location Address Fax Number:
877-747-2293
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
THELMA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
708-747-2253

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0001 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4128954 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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