1568589232 NPI number — ASSISTED LIVING CONCEPTS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568589232 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:
Provider Other Organization Name Type Code:
6
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:
1568589232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 W MICHIGAN STREET
Provider Second Line Business Mailing Address:
9TH FLOOR
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-908-8800
Provider Business Mailing Address Fax Number:
414-908-8212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2647 NW KENT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMAS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-834-3988
Provider Business Practice Location Address Fax Number:
360-834-2442
Provider Enumeration Date:
03/26/2007

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 AND CONTROLLER
Authorized Official Telephone Number:
414-908-8800

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  BH1779 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 556847 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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