Provider Demographics
NPI:1437565124
Name:MW ALEDO OPERATING, LLC
Entity Type:Organization
Organization Name:MW ALEDO OPERATING, LLC
Other - Org Name:BROOKSTONE OF ALEDO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF STRATEGIEST
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-261-7322
Mailing Address - Street 1:1270 25TH STREET PL SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-9657
Mailing Address - Country:US
Mailing Address - Phone:828-261-7322
Mailing Address - Fax:
Practice Address - Street 1:405 SE 13TH AVE
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:IL
Practice Address - Zip Code:61231-2000
Practice Address - Country:US
Practice Address - Phone:309-582-0130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility