Provider Demographics
NPI:1942085691
Name:OSL 505 SHEBOYGAN OPERATING LLC
Entity Type:Organization
Organization Name:OSL 505 SHEBOYGAN OPERATING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:TERESINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-324-5172
Mailing Address - Street 1:2448 S 102ND ST STE 305
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2141
Mailing Address - Country:US
Mailing Address - Phone:414-214-8950
Mailing Address - Fax:414-755-1315
Practice Address - Street 1:505 S WATER ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4429
Practice Address - Country:US
Practice Address - Phone:920-451-6923
Practice Address - Fax:920-451-1140
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OSL PLATINUM MANAGEMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-30
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility