Basic Information
| Provider Information | |||||||||
| NPI: | 1235327875 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ENCORE SENIOR LIVING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 SE LAKE RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | MILWAUKIE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972222129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039053347 | ||||||||
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| Practice Location | |||||||||
| Address1: | 777 E 3900 S | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841072199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012880700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2007 | ||||||||
| LastUpdateDate: | 10/09/2007 | ||||||||
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| AuthorizedOfficialLastName: | SCHOEN | ||||||||
| AuthorizedOfficialFirstName: | BRUCE | ||||||||
| AuthorizedOfficialMiddleName: | ALEXANDER | ||||||||
| AuthorizedOfficialTitleorPosition: | EX VP/CFO | ||||||||
| AuthorizedOfficialTelephone: | 5039053347 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ENCORE SM, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 2007 AL1 82151 | UT | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.