1578649687 NPI number — KALISTHENICS, INC.

Table of content: (NPI 1578649687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578649687 NPI number — KALISTHENICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KALISTHENICS, 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:
ABSOLUTE WOUNDS SOLUTIONS
Provider Other Organization Name Type Code:
3
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:
1578649687
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7444 W. WILSON AVE.
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
HARWOOD HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60706-4500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-350-1770
Provider Business Mailing Address Fax Number:
847-350-1770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7444 W. WILSON AVE.
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
HARWOOD HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60706-4500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-350-1770
Provider Business Practice Location Address Fax Number:
847-350-1770
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NAVAZIO
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Y
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
267-760-3181

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  73272 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: CSW.0002789 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: DME.000237 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 02151 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 69001172A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 16-44473 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: HME000764 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: HMEL.11616 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 15061 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 6000008483 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1313843 . This is a "HOME MEDICAL EQUIPMENT PROVIDER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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