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General NPI Number Information
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NPI Number | 1740121227
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Entity Type | Organization
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Legal Business Name | ENCORE WISCONSIN LLC
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Dates
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Enumeration Date | 04/01/2026
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Last Update Date | 04/01/2026
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Provider Practice Location Address
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Address Line | 1660 HOFFMAN RD
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City | GREEN BAY
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State | WI
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Zip | 54311-6299
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Country | US
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Telephone | 312-623-0884
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Fax | 312-284-8896
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Provider Business Mailing Address
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Address Line | 230 W MONROE ST STE 710
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City | CHICAGO
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State | IL
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Zip | 60606-4702
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Country | US
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Telephone | 312-623-0884
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS OSTROM
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Credential |
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Telephone | 312-462-4462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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