MEDICARE: ALDEN TOWN MANOR

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1386009090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALDEN TOWN MANOR

Provider Business Mailing Address
First Line	:	6120 W OGDEN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60804-3743
Country	:	US
Telephone Number	:	708-863-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	6120 W OGDEN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60804-3743
Country	:	US
Telephone Number	:	708-863-0500
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. FLOYD A SCHLOSSBERG
Credential	:
Telephone Number	:	773-286-3883

Provider Enumeration Date	:	12/22/2015
Last Update Date	:	12/22/2015

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