Provider Demographics
NPI:1235326539
Name:ASSISTED LIVING CONCEPTS INC
Entity Type:Organization
Organization Name:ASSISTED LIVING CONCEPTS INC
Other - Org Name:ASTOR HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEVONOWICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-257-8888
Mailing Address - Street 1:W140 N8981 LILLY ROAD
Mailing Address - Street 2:ATTN LEGAL DEPARTMENT
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-2325
Mailing Address - Country:US
Mailing Address - Phone:262-257-8888
Mailing Address - Fax:262-251-7633
Practice Address - Street 1:999 KLASKANINE AVENUE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103
Practice Address - Country:US
Practice Address - Phone:503-325-6970
Practice Address - Fax:503-325-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500974Medicaid