1689642969 NPI number — CHESAPEAKE REHAB EQUIPMENT INC.

Table of content: (NPI 1689642969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689642969 NPI number — CHESAPEAKE REHAB EQUIPMENT INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESAPEAKE REHAB 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:
6
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:
1689642969
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 BROOK ST STE 402
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKY HILL
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06067-3431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-447-7500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 CARSON DR.
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
BEAR
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-266-6234
Provider Business Practice Location Address Fax Number:
302-266-6232
Provider Enumeration Date:
03/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
TAMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
314-447-7515

Provider Taxonomy Codes

  • Taxonomy code: 171WH0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X , with the licence number: 1997119307 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1007514300026 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 233878504 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1689642969 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0089915 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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