Provider Demographics
NPI:1023677184
Name:ALDEN ESTATES OF COUNTRYSIDE, INC.
Entity type:Organization
Organization Name:ALDEN ESTATES OF COUNTRYSIDE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:AVELINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-724-6376
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:773-724-6376
Mailing Address - Fax:
Practice Address - Street 1:1130 COLLINS RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-2939
Practice Address - Country:US
Practice Address - Phone:920-674-3170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)