Provider Demographics
NPI:1588780035
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 1:1905 OLD NACOGDOCHES ROAD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75654
Practice Address - Country:US
Practice Address - Phone:903-657-1563
Practice Address - Fax:903-657-4693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000708310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherNATIONAL STANDARD ID