Provider Demographics
NPI:1982898003
Name:ALEDO SENIOR HOUSING LLC
Entity Type:Organization
Organization Name:ALEDO SENIOR HOUSING LLC
Other - Org Name:HERITAGE WOODS OF ALEDO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:D.
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:MOSELEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN/LNHA
Authorized Official - Phone:309-582-1132
Mailing Address - Street 1:405 SE 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:IL
Mailing Address - Zip Code:61231-2000
Mailing Address - Country:US
Mailing Address - Phone:309-582-1132
Mailing Address - Fax:309-582-1134
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:309-582-1132
Practice Address - Fax:309-582-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
IL310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility