Provider Demographics
NPI:1508164799
Name:ALDEN AT FORT HEALTHCARE, LLC
Entity type:Organization
Organization Name:ALDEN AT FORT HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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:
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:773-286-3743
Practice Address - Street 1:611 SHERMAN AVENUE EAST
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-1960
Practice Address - Country:US
Practice Address - Phone:920-568-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI525620Medicare Oscar/Certification