MEDICARE: ALDEN-LINCOLN PARK REHABILITATION AND HEALTH CARE CENTER, 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	0040709	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1116	OTHER	IL	BLUE CROSS

General Provider Information

NPI Number	:	1336136803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALDEN-LINCOLN PARK REHABILITATION AND HEALTH CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	4200 W PETERSON AVE
Second Line	:	SUITE 140
City	:	CHICAGO
State	:	IL
Zip	:	60646-6074
Country	:	US
Telephone Number	:	772-286-6622
Fax Number	:	773-286-2150

Provider Business Practice Location Address
First Line	:	504 W WELLINGTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5421
Country	:	US
Telephone Number	:	773-281-6200
Fax Number	:	773-281-5623

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FLOYD A SCHLOSSBERG
Credential	:
Telephone Number	:	773-286-6622

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	06/28/2010

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