Basic Information
| Provider Information | |||||||||
| NPI: | 1679699128 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ASSISTED LIVING CONCEPTS INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | KARR 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: | 1649 BROADWAY AVENUE | ||||||||
| Address2: | |||||||||
| City: | HOQUIAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605323007 | ||||||||
| FaxNumber: | 3605336236 | ||||||||
| 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 | BH1773 | WA | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
ID Information
| ID | Type | State | Issuer | Description | 115707 | 05 | WA | MEDICAID |