Healthcare Provider Details

I. General information

NPI: 1851849269
Provider Name (Legal Business Name): ALDEN COURTS OF WATERFORD, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 07/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

1991 RANDI DR
AURORA IL
60504-4757
US

V. Phone/Fax

Practice location:
  • Phone: 773-286-6622
  • Fax:
Mailing address:
  • Phone: 630-851-1466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

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