1336334929 NPI number — ASSISTED LIVING CONCEPTS INC

Table of content: (NPI 1336334929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336334929 NPI number — ASSISTED LIVING CONCEPTS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSISTED LIVING CONCEPTS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ROSEWIND HOUSE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336334929
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5815 COFFEY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN CITY
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-377-9980
Provider Business Practice Location Address Fax Number:
208-373-0684
Provider Enumeration Date:
09/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LEVONOWICH
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
A
Authorized Official Title or Position:
VICE PRESIDENT CONTROLLER
Authorized Official Telephone Number:
262-250-4500

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  RC545 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)