MEDICARE: ALDEN ESTATES-COURTS OF HUNTLEY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

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

Provider Business Mailing Address
First Line	:	12140A REGENCY PKWY
Second Line	:
City	:	HUNTLEY
State	:	IL
Zip	:	60142-7553
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 W PETERSON AVE STE 140
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-6819
Country	:	US
Telephone Number	:	773-286-6622
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RANDI SCHULLO
Credential	:
Telephone Number	:	773-724-6324

Provider Enumeration Date	:	02/26/2018
Last Update Date	:	03/17/2018

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