MEDICARE: ENCORE SENIOR LIVING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	2007 AL1 82151	UT

General Provider Information

NPI Number	:	1235327875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENCORE SENIOR LIVING, LLC

Provider Business Mailing Address
First Line	:	6400 SE LAKE RD
Second Line	:	SUITE 400
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-2129
Country	:	US
Telephone Number	:	503-905-3347
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 E 3900 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-2199
Country	:	US
Telephone Number	:	801-288-0700
Fax Number	:

Authorized Official
Title or Position	:	EX VP/CFO
Name	:	MR. BRUCE ALEXANDER SCHOEN
Credential	:
Telephone Number	:	503-905-3347

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	10/09/2007

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