Healthcare Provider Details

I. General information

NPI: 1053812974
Provider Name (Legal Business Name): ALDEN ESTATES-COURTS OF HUNTLEY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 W PETERSON AVE STE 140
CHICAGO IL
60646-6819
US

IV. Provider business mailing address

12140A REGENCY PKWY
HUNTLEY IL
60142-7553
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: RANDI SCHULLO
Title or Position: PRESIDENT
Credential:
Phone: 773-724-6324