Healthcare Provider Details

I. General information

NPI: 1770039075
Provider Name (Legal Business Name): ALDEN COURTS OF SHOREWOOD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
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

700 W. BLACK RD.
SHOREWOOD IL
60404-8400
US

V. Phone/Fax

Practice location:
  • Phone: 773-286-6622
  • Fax:
Mailing address:
  • Phone: 815-230-8700
  • 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: JOHN AVELINO
Title or Position: ACCOUNT RECEIVABLE MANAGER
Credential:
Phone: 773-724-6376