Provider Demographics
NPI:1104129006
Name:CAL'S MEDICAL ENTERPRISES, SERVICE CORPORATION
Entity type:Organization
Organization Name:CAL'S MEDICAL ENTERPRISES, SERVICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:V
Authorized Official - Last Name:HEARN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:708-333-6660
Mailing Address - Street 1:PO BOX 2032
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60017-2032
Mailing Address - Country:US
Mailing Address - Phone:708-333-6660
Mailing Address - Fax:580-510-0514
Practice Address - Street 1:515 W TAFT DR
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2030
Practice Address - Country:US
Practice Address - Phone:708-333-6660
Practice Address - Fax:580-510-0514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054016335333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid