Healthcare Provider Details

I. General information

NPI: 1194847814
Provider Name (Legal Business Name): ASSISTED LIVING CONCEPTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 WEST BROADWAY
APACHE JUNCTION AZ
85220
US

IV. Provider business mailing address

111 W MICHIGAN STREET 9TH FLOOR
MILWAUKEE WI
53203
US

V. Phone/Fax

Practice location:
  • Phone: 480-288-1791
  • Fax: 480-671-9660
Mailing address:
  • Phone: 414-908-8800
  • Fax: 414-908-8212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALC4597
License Number StateAZ

VIII. Authorized Official

Name: MR. WALTER A LEVONOWICH
Title or Position: VICE PRESIDENT AND CONTROLLER
Credential:
Phone: 414-908-8800