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General NPI Number Information
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NPI Number | 1336334929
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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 | 09/07/2007
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | 5815 COFFEY STREET
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City | GARDEN CITY
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State | ID
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Zip | 83714
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Country | US
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Telephone | 208-377-9980
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Fax | 208-373-0684
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Provider Business Mailing Address
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Address Line | W140 N8981 LILLY ROAD ATTN LEGAL DEPARTMENT
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-2325
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Country | US
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Telephone | 262-250-4500
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Fax | 262-251-7633
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Authorized Official
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Title or Position | VICE PRESIDENT CONTROLLER
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Name | WALTER A LEVONOWICH
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Credential |
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Telephone | 262-250-4500
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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 | RC545
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License Number State | ID
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