City Wide Village Mattress

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

Legal business name

CITY WIDE VILLAGE MATTRESS

Practice address

700 W Jefferson St
Route 52
Shorewood, IL 60404-7608

Phone

(815) 744-5212

Fax

(815) 744-5620

NPI assigned

Sep 12, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Rickey Jennings Brocies

Title

President/Owner

Phone

(815) 744-5212

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347408000000",
    "number": "1538419072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 W JEFFERSON ST",
            "address_2": "ROUTE 52",
            "city": "SHOREWOOD",
            "state": "IL",
            "postal_code": "604047608",
            "telephone_number": "815-744-5212",
            "fax_number": "815-744-5620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W JEFFERSON ST",
            "address_2": "ROUTE 52",
            "city": "SHOREWOOD",
            "state": "IL",
            "postal_code": "604047608",
            "telephone_number": "815-744-5212",
            "fax_number": "815-744-5620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY WIDE VILLAGE MATTRESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-12",
        "last_updated": "2012-09-12",
        "status": "A",
        "authorized_official_last_name": "BROCIES",
        "authorized_official_first_name": "RICKEY",
        "authorized_official_middle_name": "JENNINGS",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "815-744-5212",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Customized Equipment (DME) in Shorewood, IL
• Providers in Shorewood, IL by specialty
• Customized Equipment (DME) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.