14D0950867 CLIA NUMBER - ALDEN OF OLD TOWN WEST

Laboratory Demographics

CLIA Number: 14D0950867

Facility Name: ALDEN OF OLD TOWN WEST

Facility Address:
118 SOUTH BLOOMINGDALE ROAD
BLOOMINGDALE, IL
ZIP 60108
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Facility Phone Number: 630 671-1660

Facility Type: Intermediate Care Facility for Mentally Retarded

Certificate Type: Waiver

NPI Number: 1932564762

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	14D0950867
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	ALDEN OF OLD TOWN WEST
Street	118 SOUTH BLOOMINGDALE ROAD
City	BLOOMINGDALE
State	IL
ZIP	60108
Phone	630 671-1660
CertificateType	4
CertificateEffectiveDate	9/9/2022
CertificateExpirationDate	9/8/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024