MEDICARE: SNH AL AIMO TENANT, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311500000X	Alzheimer Center (Dementia Center)
2	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1649909789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SNH AL AIMO TENANT, INC.

Provider Business Mailing Address
First Line	:	2705 AVENUE E
Second Line	:
City	:	STERLING
State	:	IL
Zip	:	61081-9016
Country	:	US
Telephone Number	:	815-622-2800
Fax Number	:	815-622-2801

Provider Business Practice Location Address
First Line	:	2705 AVENUE E
Second Line	:
City	:	STERLING
State	:	IL
Zip	:	61081-9016
Country	:	US
Telephone Number	:	815-622-2800
Fax Number	:	815-622-2801

Authorized Official
Title or Position	:	C.F.O & TREASURER
Name	:	RICHARD W. SIEDEL JR.
Credential	:
Telephone Number	:	617-796-8350

Provider Enumeration Date	:	06/06/2022
Last Update Date	:	06/06/2022

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