Provider Demographics
NPI:1073387668
Name:OSSEO ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:OSSEO ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ISAAK
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKOVITS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-448-6200
Mailing Address - Street 1:1632 61ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-2109
Mailing Address - Country:US
Mailing Address - Phone:608-448-6200
Mailing Address - Fax:
Practice Address - Street 1:51017 RIDGEVIEW RD
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:WI
Practice Address - Zip Code:54758-2801
Practice Address - Country:US
Practice Address - Phone:715-597-2493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility