| Organization Name: | BM OF CHICAGO RIDGE LLC |
| NPI Number: | 1669626693 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID LUBOWSKY (BOOKKEEPER) |
| Mailing Address: | 10602 Southwest Hwy Chicago Ridge |
| State: | IL US |
| Postal Code: | 604151429 |
| Phone Number: | 7084481540 |
| Fax Number: | |
| NPI Enumeration Date: | 11/04/2008 |
| NPI Last Update Date: | 11/04/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BX2000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Oxygen Equipment & Supplies |
| Taxonomy Definition: | |