1417112210 NPI number — ASSISTED LIVING CONCEPTS, INC.

Table of content: (NPI 1417112210)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417112210 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:
1417112210
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
W140N8981 LILLY RD
Provider Second Line Business Mailing Address:
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:
262-257-8888
Provider Business Mailing Address Fax Number:
262-251-7633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
475 ROCHESTER HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SENECA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29672-2475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-886-0070
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ZAK-KOWALCZYK
Authorized Official First Name:
MARY
Authorized Official Middle Name:
T
Authorized Official Title or Position:
SENIOR CORPORATION COUNSEL
Authorized Official Telephone Number:
262-257-8888

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  SC29672 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com