Provider Demographics
NPI:1164869079
Name:ENCORE SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:ENCORE SENIOR LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EX VO/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHOEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-905-3347
Mailing Address - Street 1:6400 SE LAKE RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2129
Mailing Address - Country:US
Mailing Address - Phone:503-905-3347
Mailing Address - Fax:503-905-3333
Practice Address - Street 1:840 E DALTON AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-9338
Practice Address - Country:US
Practice Address - Phone:208-665-2100
Practice Address - Fax:208-665-9250
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENCORE SM, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-31
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRC-1049310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility