Basic Information
| Provider Information | |||||||||
| NPI: | 1154978260 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SNH NM TENANT LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE MONTEBELLO ON ACADEMY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 WASHINGTON ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024581634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177968350 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10500 ACADEMY RD NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871117306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052949944 | ||||||||
| FaxNumber: | 5052941808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2019 | ||||||||
| LastUpdateDate: | 10/11/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MINTZER | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | F. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6177968350 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SNH NM TENANT LLC | ||||||||
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| NPICertificationDate: | 10/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | N | Nursing & Custodial Care Facilities | Skilled Nursing Facility | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.