Provider Demographics
NPI:1366513442
Name:ANGELCARE AND MEDICAL EQUIPMENT SUPPLY COMPANY INC
Entity type:Organization
Organization Name:ANGELCARE AND MEDICAL EQUIPMENT SUPPLY COMPANY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AZUKA
Authorized Official - Middle Name:VALENTINE
Authorized Official - Last Name:DIBIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-602-2170
Mailing Address - Street 1:66 E 71ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-1030
Mailing Address - Country:US
Mailing Address - Phone:773-602-2170
Mailing Address - Fax:
Practice Address - Street 1:66 E 71ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-1030
Practice Address - Country:US
Practice Address - Phone:773-602-2170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-12
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL5865230001Medicare NSC