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NPI Code Detail

MEDICARE: ALLURE OF MENDOTA, LLC

MEDICARE: ALLURE OF MENDOTA, 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
1332BX2000XOxygen Equipment & Supplies (DME)

General Provider Information

NPI Number : 1376237933
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALLURE OF MENDOTA, 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 :
Provider Business Practice Location Address
First Line : 1201 1ST AVE
Second Line :
City : MENDOTA
State : IL
Zip : 61342-1815
Country : US
Telephone Number : 815-539-6745
Fax Number :
Authorized Official
Title or Position : VICE PRESIDENT
Name : MICHAEL NUDELL
Credential :
Telephone Number : 773-338-4400
Provider Enumeration Date : 06/06/2023
Last Update Date : 08/31/2023

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Directions to “ALLURE OF MENDOTA, LLC ” Practice Location

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