Healthcare Provider Details

I. General information

NPI: 1891783627
Provider Name (Legal Business Name): ALDEN OF OLD TOWN EAST, INC.
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

108 1ST ST
BLOOMINGDALE IL
60108-1220
US

IV. Provider business mailing address

4200 W PETERSON AVE SUITE 140
CHICAGO IL
60646-6074
US

V. Phone/Fax

Practice location:
  • Phone: 630-671-1703
  • Fax: 630-671-1706
Mailing address:
  • Phone: 773-286-6622
  • Fax: 773-286-2150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number0042069
License Number StateIL

VIII. Authorized Official

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