Provider Demographics
NPI:1033106596
Name:ALDEN-LAKELAND REHABILITATION AND HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:ALDEN-LAKELAND REHABILITATION AND HEALTH CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHLOSSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-286-6622
Mailing Address - Street 1:4200 W PETERSON AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-6074
Mailing Address - Country:US
Mailing Address - Phone:773-286-6622
Mailing Address - Fax:773-286-2150
Practice Address - Street 1:820 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4213
Practice Address - Country:US
Practice Address - Phone:773-769-2570
Practice Address - Fax:773-769-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0017319314000000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0939OtherBLUE CROSS
IL0939OtherBLUE CROSS
IL=========001Medicaid