MEDICARE: ALDEN-LONG GROVE 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	0040683	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1113	OTHER	IL	BLUE CROSS

General Provider Information

NPI Number	:	1972590230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALDEN-LONG GROVE 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	:	773-286-6622
Fax Number	:	773-286-2150

Provider Business Practice Location Address
First Line	:	BOX 2308 OLD HICKS ROAD
Second Line	:
City	:	LONG GROVE
State	:	IL
Zip	:	60047-8373
Country	:	US
Telephone Number	:	847-438-8275
Fax Number	:	847-438-3254

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

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	06/28/2010

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