Basic Information
| Provider Information | |||||||||
| NPI: | 1659736353 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALDEN VALLEY RIDGE REHAB. AND HEALTH CARE CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 275 E ARMY TRAIL RD | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGDALE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601082135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308939616 | ||||||||
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| Practice Location | |||||||||
| Address1: | 275 E ARMY TRAIL RD | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGDALE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601082135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308939616 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2015 | ||||||||
| LastUpdateDate: | 12/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | SCHLOSSBERG | ||||||||
| AuthorizedOfficialFirstName: | FLOYD | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7732863883 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.