Provider Demographics
NPI:1477541290
Name:SENIOR LIVING PROPERTIES
Entity Type:Organization
Organization Name:SENIOR LIVING PROPERTIES
Other - Org Name:ALDERWOOD HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-740-4750
Mailing Address - Street 1:746 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-1424
Mailing Address - Country:US
Mailing Address - Phone:847-697-0565
Mailing Address - Fax:847-697-0568
Practice Address - Street 1:746 W SPRING ST
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-1424
Practice Address - Country:US
Practice Address - Phone:847-697-0565
Practice Address - Fax:847-697-0568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1611973302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========Medicaid
IL145825Medicare ID - Type Unspecified