Healthcare Provider Details

I. General information

NPI: 1053007443
Provider Name (Legal Business Name): ALLURE OF MENDOTA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 1ST AVE
MENDOTA IL
61342-1815
US

IV. Provider business mailing address

2711 W HOWARD ST
CHICAGO IL
60645-1303
US

V. Phone/Fax

Practice location:
  • Phone: 815-539-6745
  • Fax:
Mailing address:
  • Phone: 773-338-4400
  • Fax: 773-338-4414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA MEYER
Title or Position: VICE PRESIDENT
Credential:
Phone: 733-384-4007