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General NPI Number Information
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NPI Number | 1447988803
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Entity Type | Organization
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Legal Business Name | BLEU LOTUS 360 LLC
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Dates
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Enumeration Date | 08/12/2022
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Last Update Date | 08/12/2022
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Provider Practice Location Address
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Address Line | 1600 N STATE ROUTE 50 STE 726
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City | BOURBONNAIS
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State | IL
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Zip | 60914-9314
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Country | US
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Telephone | 815-585-6669
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Fax |
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Provider Business Mailing Address
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Address Line | 122 S MICHIGAN AVE STE 1390
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City | CHICAGO
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State | IL
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Zip | 60603-6036
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Country | US
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Telephone | 773-739-6024
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Fax |
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Authorized Official
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Title or Position | RN
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Name | MS. MACHADA ALLAYNA CURETON
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Credential | MACHADA CURETON
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Telephone | 773-739-6024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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