Healthcare Provider Details

I. General information

NPI: 1336334929
Provider Name (Legal Business Name): ASSISTED LIVING CONCEPTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5815 COFFEY STREET
GARDEN CITY ID
83714
US

IV. Provider business mailing address

W140 N8981 LILLY ROAD ATTN LEGAL DEPARTMENT
MENOMONEE FALLS WI
53051-2325
US

V. Phone/Fax

Practice location:
  • Phone: 208-377-9980
  • Fax: 208-373-0684
Mailing address:
  • Phone: 262-250-4500
  • Fax: 262-251-7633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberRC545
License Number StateID

VIII. Authorized Official

Name: WALTER A LEVONOWICH
Title or Position: VICE PRESIDENT CONTROLLER
Credential:
Phone: 262-250-4500