Healthcare Provider Details

I. General information

NPI: 1902735251
Provider Name (Legal Business Name): SHAWANO PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1088 ENGEL DR
SHAWANO WI
54166-3746
US

IV. Provider business mailing address

230 W MONROE ST STE 710
CHICAGO IL
60606-4702
US

V. Phone/Fax

Practice location:
  • Phone: 312-462-4462
  • Fax:
Mailing address:
  • Phone: 312-462-4462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS M OSTROM
Title or Position: CEO
Credential:
Phone: 312-623-0884