Provider Demographics
NPI:1386009090
Name:ALDEN TOWN MANOR
Entity Type:Organization
Organization Name:ALDEN TOWN MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHLOSSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-286-3883
Mailing Address - Street 1:6120 W OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-3743
Mailing Address - Country:US
Mailing Address - Phone:708-863-0500
Mailing Address - Fax:
Practice Address - Street 1:6120 W OGDEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60804-3743
Practice Address - Country:US
Practice Address - Phone:708-863-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies