Provider Demographics
NPI:1194847814
Name:ASSISTED LIVING CONCEPTS INC
Entity Type:Organization
Organization Name:ASSISTED LIVING CONCEPTS INC
Other - Org Name:AURORA HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT AND CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEVONOWICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-908-8800
Mailing Address - Street 1:111 W MICHIGAN STREET
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203
Mailing Address - Country:US
Mailing Address - Phone:414-908-8800
Mailing Address - Fax:414-908-8212
Practice Address - Street 1:675 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85220
Practice Address - Country:US
Practice Address - Phone:480-288-1791
Practice Address - Fax:480-671-9660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALC4597310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ420753Medicaid