Basic Information
| Provider Information | |||||||||
| NPI: | 1508164799 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALDEN AT FORT HEALTHCARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4200 W PETERSON AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606466074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732866622 | ||||||||
| FaxNumber: | 7732863743 | ||||||||
| Practice Location | |||||||||
| Address1: | 611 SHERMAN AVENUE EAST | ||||||||
| Address2: | |||||||||
| City: | FORT ATKINSON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535381960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9205685000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2011 | ||||||||
| LastUpdateDate: | 05/11/2011 | ||||||||
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| AuthorizedOfficialLastName: | SCHLOSSBERG | ||||||||
| AuthorizedOfficialFirstName: | FLOYD | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7732866622 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.