Healthcare Provider Details

I. General information

NPI: 1962128538
Provider Name (Legal Business Name): ALLURE OF PINECREST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 S WESLEY AVE
MOUNT MORRIS IL
61054-1428
US

IV. Provider business mailing address

2711 W HOWARD ST
CHICAGO IL
60645-1303
US

V. Phone/Fax

Practice location:
  • Phone: 815-734-4103
  • Fax: 815-743-7318
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: MR. BRUCE HARRIS
Title or Position: CFO
Credential:
Phone: 773-338-4400