Provider Demographics
NPI:1104664408
Name:ENCORE MCHENRY LLC
Entity type:Organization
Organization Name:ENCORE MCHENRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROTH
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-258-0409
Mailing Address - Street 1:230 W MONROE ST STE 710
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-4702
Mailing Address - Country:US
Mailing Address - Phone:563-258-0409
Mailing Address - Fax:
Practice Address - Street 1:805 S BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-4992
Practice Address - Country:US
Practice Address - Phone:563-258-0409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility