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General NPI Number Information
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NPI Number | 1801850177
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Entity Type | Organization
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Legal Business Name | AMERICAN LUTHERAN CHURCH MENDOTA
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 02/26/2019
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Provider Practice Location Address
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Address Line | 500 6TH ST
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City | MENDOTA
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State | IL
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Zip | 61342-1728
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Country | US
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Telephone | 815-539-7439
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Fax | 815-538-3400
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Provider Business Mailing Address
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Address Line | 500 6TH ST
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City | MENDOTA
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State | IL
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Zip | 61342-1728
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Country | US
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Telephone | 815-539-7439
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Fax | 815-538-3400
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ERICA A. FALK
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Credential | MBA, LNHA
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Telephone | 815-539-7439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 0011593
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License Number State | IL
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