Basic Information
| Provider Information | |||||||||
| NPI: | 1689642969 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHESAPEAKE REHAB EQUIPMENT INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2070 LITTLE HILLS EXPY | ||||||||
| Address2: | |||||||||
| City: | SAINT CHARLES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633013708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144477500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 227 LAKE DRIVE | ||||||||
| Address2: | PENCADER CORPORATE CENTER | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197023320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3022666234 | ||||||||
| FaxNumber: | 3022666232 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2006 | ||||||||
| LastUpdateDate: | 02/16/2022 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | WALTER | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING AND LICENSURE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3144477515 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CHESAPEAKE REHAB EQUIPMENT INC. | ||||||||
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| NPICertificationDate: | 02/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171WH0202X | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Contractor | Home Modifications | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BC3200X | 1997119307 | DE | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
ID Information
| ID | Type | State | Issuer | Description | 1689642969 | 05 | DE | MEDICAID | 0089915 | 05 | NJ | MEDICAID | 233878504 | 05 | MD | MEDICAID | 1007514300026 | 05 | PA | MEDICAID |