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General NPI Number Information
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NPI Number | 1184746802
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Entity Type | Organization
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Legal Business Name | ASSISTED LIVING CONCEPTS INC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10401 NORTH 79TH AVENUE
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City | PEORIA
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State | AZ
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Zip | 85345
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Country | US
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Telephone | 623-979-5259
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Fax | 623-773-1917
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Provider Business Mailing Address
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Address Line | 111 W MICHIGAN STREET 9TH FLOOR
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City | MILWAUKEE
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State | WI
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Zip | 53203
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Country | US
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Telephone | 414-908-8800
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Fax | 414-908-8212
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Authorized Official
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Title or Position | VICE PRESIDENT AND CONTROLLER
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Name | MR. WALTER A LEVONOWICH
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Credential |
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Telephone | 414-908-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | ALC2327
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License Number State | AZ
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