Basic Information
| Provider Information | |||||||||
| NPI: | 1316063951 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ASSISTED LIVING CONCEPTS INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CHAPIN HOUSE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 W MICHIGAN STREET | ||||||||
| Address2: | 9TH FLOOR | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4149088800 | ||||||||
| FaxNumber: | 4149088212 | ||||||||
| Practice Location | |||||||||
| Address1: | 1042 ROUTE 47 NORTH | ||||||||
| Address2: | |||||||||
| City: | RIO GRANDE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098867900 | ||||||||
| FaxNumber: | 6098868029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LEVONOWICH | ||||||||
| AuthorizedOfficialFirstName: | WALTER | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT AND CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 4149088800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 20A000 | NJ | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
ID Information
| ID | Type | State | Issuer | Description | 7154658 | 05 | NJ | MEDICAID |