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NPI Code Detail

MEDICARE: ASSISTED LIVING CONCEPTS, LLC

MEDICARE: ASSISTED LIVING CONCEPTS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1310400000XAssisted Living Facility2199WA

General Provider Information

NPI Number : 1598155269
Entity Type Code : Organization
Provider Name (Legal Business Name) : ASSISTED LIVING CONCEPTS, LLC
Provider Business Mailing Address
First Line : 330 N WABASH AVE
Second Line : SUITE 3700
City : CHICAGO
State : IL
Zip : 60611-3586
Country : US
Telephone Number : 312-725-7000
Fax Number :
Provider Business Practice Location Address
First Line : 2647 NW KENT ST
Second Line :
City : CAMAS
State : WA
Zip : 98607-9026
Country : US
Telephone Number : 360-834-3988
Fax Number : 360-834-2442
Authorized Official
Title or Position : COO
Name : DANIEL GUILL
Credential :
Telephone Number : 312-725-7072
Provider Enumeration Date : 02/02/2015
Last Update Date : 02/02/2015

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Directions to “ASSISTED LIVING CONCEPTS, LLC ” Practice Location

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