=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689526766
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OSL PLATINUM OPERATING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2026
-----------------------------------------------------
Last Update Date | 02/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2448 S 102ND ST STE 305
-----------------------------------------------------
City | WEST ALLIS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53227-2141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-214-8991
-----------------------------------------------------
Fax | 262-364-2794
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2448 S 102ND ST STE 305
-----------------------------------------------------
City | WEST ALLIS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53227-2141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-214-8991
-----------------------------------------------------
Fax | 262-364-2794
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP
-----------------------------------------------------
Name | MATT TERESINSKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-617-6337
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------