Basic Information
| Provider Information | |||||||||
| NPI: | 1992195259 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ASSISTED LIVING CONCEPTS, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CHENOWETH HOUSE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 N WABASH AVE | ||||||||
| Address2: | SUITE 3700 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606113586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3127257000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1108 W 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993367002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095820207 | ||||||||
| FaxNumber: | 5095859138 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2015 | ||||||||
| LastUpdateDate: | 01/26/2015 | ||||||||
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| AuthorizedOfficialLastName: | GUILL | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 3127257072 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 2193 | WA | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.