American Lutheran Church Mendota

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

0011593 Issued in IL

Legal business name

AMERICAN LUTHERAN CHURCH MENDOTA

Doing business as

Mendota Lutheran Home

Practice address

500 6TH St
Mendota, IL 61342-1728

Phone

(815) 539-7439

Fax

(815) 538-3400

NPI assigned

Apr 13, 2006

Last updated

Feb 26, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Erica A. Falk, MBA, LNHA

Title

Administrator

Phone

(815) 539-7439

Specialties & licenses 1

Addresses

Other names 1

• Mendota Lutheran Home Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Phillip Alan Davis, LSW

  • Clinical Social Worker
  • Rockford, IL
  • NPI 1891370201
  NPD

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

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551139200000",
    "number": "1801850177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 6TH ST",
            "city": "MENDOTA",
            "state": "IL",
            "postal_code": "613421728",
            "telephone_number": "815-539-7439",
            "fax_number": "815-538-3400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 6TH ST",
            "city": "MENDOTA",
            "state": "IL",
            "postal_code": "613421728",
            "telephone_number": "815-539-7439",
            "fax_number": "815-538-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMERICAN LUTHERAN CHURCH MENDOTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-13",
        "last_updated": "2019-02-26",
        "status": "A",
        "authorized_official_last_name": "FALK",
        "authorized_official_first_name": "ERICA",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "815-539-7439",
        "authorized_official_credential": "MBA, LNHA"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "IL",
            "license": "0011593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mendota Lutheran Home",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mendota Lutheran Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Allure of Mendota, LLC
• Allure of Mendota, LLC
• Associated Physicians, SC
• Abdul Moyeed Atif, PHARMD
• Richard Jospeh Baker
• Balanced Family Chiropractic LTD
• Reid Baltikauski, DPT

• Nursing Facility/Intermediate Care Facility in Mendota, IL
• Providers in Mendota, IL by specialty
• Nursing Facility/Intermediate Care Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2019; 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.