Provider Demographics
NPI:1952501801
Name:LERU,INC.
Entity Type:Organization
Organization Name:LERU,INC.
Other - Org Name:MERLE NORMAN COSMETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SEC/TRES
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:L
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:815-264-9012
Mailing Address - Street 1:123 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5326
Mailing Address - Country:US
Mailing Address - Phone:630-668-6685
Mailing Address - Fax:
Practice Address - Street 1:123 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5326
Practice Address - Country:US
Practice Address - Phone:630-668-6685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5501870001Medicare NSC