The Encore at Mahtomedi

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

THE ENCORE AT MAHTOMEDI

Practice address

720 Mahtomedi Ave
Saint Paul, MN 55115-1671

Phone

(651) 528-8442

NPI assigned

Jan 14, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Thomas Millard Ostrom

Title

President

Phone

(312) 623-0884

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583193600000",
    "number": "1255971685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 N WACKER DR STE 608",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606061726",
            "telephone_number": "312-623-0884",
            "fax_number": "312-462-4462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 MAHTOMEDI AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551151671",
            "telephone_number": "651-528-8442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE ENCORE AT MAHTOMEDI",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-14",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A",
        "authorized_official_last_name": "OSTROM",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "MILLARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-623-0884",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Dental Specialist of Minnesota, PLLC
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• The Emeralds at St Paul LLC
• The Emily Program
• The Evangelical Lutheran Good Samaritan Society
• The Experience of Neshama
• The Family Development Center
• The Family Development Center Foundation
• The Family Development Center, LLC

• Assisted Living Facility in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Assisted Living Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.