MEDICARE: ASSISTED LIVING CONCEPTS INC

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
1	310400000X	Assisted Living Facility	S0013	IA

General Provider Information

NPI Number	:	1730376054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSISTED LIVING CONCEPTS INC

Provider Business Mailing Address
First Line	:	W140 N8981 LILLY ROAD
Second Line	:	LEGAL DEPARTMENT
City	:	MENOMONEE FALLS
State	:	WI
Zip	:	53051-2325
Country	:	US
Telephone Number	:	262-250-4500
Fax Number	:	262-251-7633

Provider Business Practice Location Address
First Line	:	2506 3RD AVENUE
Second Line	:
City	:	NORTH DENISON
State	:	IA
Zip	:	51442
Country	:	US
Telephone Number	:	712-283-8657
Fax Number	:	712-263-2371

Authorized Official
Title or Position	:	VICE PRESIDENT CONTROLLER
Name	:	WALTER A LEVONOWICH
Credential	:
Telephone Number	:	262-257-8888

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	10/01/2007

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