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NPI Code Detail

MEDICARE: ALLURE OF PINECREST LLC

MEDICARE: ALLURE OF PINECREST LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1962128538
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALLURE OF PINECREST LLC
Provider Business Mailing Address
First Line : 2711 W HOWARD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60645-1303
Country : US
Telephone Number : 773-338-4400
Fax Number : 773-338-4414
Provider Business Practice Location Address
First Line : 414 S WESLEY AVE
Second Line :
City : MOUNT MORRIS
State : IL
Zip : 61054-1428
Country : US
Telephone Number : 815-734-4103
Fax Number : 815-743-7318
Authorized Official
Title or Position : CFO
Name : MR. BRUCE HARRIS
Credential :
Telephone Number : 773-338-4400
Provider Enumeration Date : 10/17/2022
Last Update Date : 10/17/2022

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Directions to “ALLURE OF PINECREST LLC ” Practice Location

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