Organization
THE ENCORE AT MAHTOMEDI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS MILLARD OSTROM (PRESIDENT)
(312) 623-0884
Entity
Organization
Contact information
Practice address
720 MAHTOMEDI AVE, SAINT PAUL, MN 55115-1671
(651) 528-8442
Mailing address
101 N WACKER DR STE 608, CHICAGO, IL 60606-1726
(312) 623-0884
(312) 462-4462
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
01/14/2020
Last updated
03/03/2020
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