Basic Information
Provider Information | |||||||||
NPI: | 1033317078 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ENCORE SENIOR LIVING II, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6400 SE LAKE RD | ||||||||
Address2: | SUITE 400 | ||||||||
City: | MILWAUKIE | ||||||||
State: | OR | ||||||||
PostalCode: | 972222129 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5039053300 | ||||||||
FaxNumber: | 5039053333 | ||||||||
Practice Location | |||||||||
Address1: | 777 E 3900 S | ||||||||
Address2: |   | ||||||||
City: | SALT LAKE CITY | ||||||||
State: | UT | ||||||||
PostalCode: | 841072199 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8012880700 | ||||||||
FaxNumber: | 8012882777 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/10/2007 | ||||||||
LastUpdateDate: | 10/09/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SCHOEN | ||||||||
AuthorizedOfficialFirstName: | BRUCE | ||||||||
AuthorizedOfficialMiddleName: | ALEXANDER | ||||||||
AuthorizedOfficialTitleorPosition: | EX VICE PRESIDENT/CFO | ||||||||
AuthorizedOfficialTelephone: | 5039053347 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | ENCORE SENIOR LIVING, LLC | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 2006-ALI-841 | UT | Y |   | Nursing & Custodial Care Facilities | Assisted Living Facility |   |
No ID Information.