Healthcare Provider Details

I. General information

NPI: 1104477736
Provider Name (Legal Business Name): ALDEN OF WATERFORD, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 RANDI DR
AURORA IL
60504-4758
US

IV. Provider business mailing address

4200 W PETERSON AVE
CHICAGO IL
60646-6074
US

V. Phone/Fax

Practice location:
  • Phone: 630-851-7266
  • Fax:
Mailing address:
  • Phone: 773-724-6373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: JOHN AVELINO
Title or Position: ACCOUNTS RECEIVABLE MANAGER
Credential:
Phone: 773-724-6376