Provider Demographics
NPI:1184746802
Name:ASSISTED LIVING CONCEPTS INC
Entity type:Organization
Organization Name:ASSISTED LIVING CONCEPTS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:10401 NORTH 79TH AVENUE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345
Practice Address - Country:US
Practice Address - Phone:623-979-5259
Practice Address - Fax:623-773-1917
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
AZALC2327310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ483694Medicaid