Organization
THE WEAVE LUXE BAR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAYLAN PITTARD (OWNER)
(630) 506-1551
Entity
Organization
Contact information
Practice address
7315 LEMONT RD, DOWNERS GROVE, IL 60516-3807
(630) 506-1551
(252) 650-6564
Mailing address
7315 LEMONT RD, DOWNERS GROVE, IL 60516-3807
(630) 506-1551
(252) 650-6564
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
04/14/2020
Last updated
04/14/2020
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