Healthcare Provider Details

I. General information

NPI: 1760470553
Provider Name (Legal Business Name): ALDEN OF WATERFORD, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 08/22/2020
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 SUITE 140
CHICAGO IL
60646-6074
US

V. Phone/Fax

Practice location:
  • Phone: 630-851-7266
  • Fax: 630-851-7585
Mailing address:
  • Phone: 773-286-6622
  • Fax: 773-286-2150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0042036
License Number StateIL

VIII. Authorized Official

Name: FLOYD A SCHLOSSBERG
Title or Position: PRESIDENT
Credential:
Phone: 773-286-6622