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Organization
CITY WIDE VILLAGE MATTRESS
Active
Organization
CITY WIDE VILLAGE MATTRESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICKEY JENNINGS BROCIES (PRESIDENT/OWNER)
(815) 744-5212
Entity
Organization
Contact information
Practice address
700 W JEFFERSON ST, ROUTE 52, SHOREWOOD, IL 60404-7608
(815) 744-5212
(815) 744-5620
Mailing address
700 W JEFFERSON ST, ROUTE 52, SHOREWOOD, IL 60404-7608
(815) 744-5212
(815) 744-5620
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
09/12/2012
Last updated
09/12/2012
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