Healthcare Provider Details

I. General information

NPI: 1972590230
Provider Name (Legal Business Name): ALDEN-LONG GROVE REHABILITATION AND HEALTH CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOX 2308 OLD HICKS ROAD
LONG GROVE IL
60047-8373
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 847-438-8275
  • Fax: 847-438-3254
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 Number0040683
License Number StateIL

VIII. Authorized Official

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