Basic Information
| Provider Information | |||||||||
| NPI: | 1659925428 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SNH TOTO TENANT LLC | ||||||||
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| OtherOrganizationName: | BRANDON WOODS AT ALVAMAR | ||||||||
| 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: | 6177968349 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 INVERNESS DR | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660471870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858388000 | ||||||||
| FaxNumber: | 7858388001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2019 | ||||||||
| LastUpdateDate: | 05/07/2020 | ||||||||
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| AuthorizedOfficialLastName: | MINTZER | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | F. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6177968350 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SNH TOTO TENANT LLC | ||||||||
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| NPICertificationDate: | 05/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | N | Nursing & Custodial Care Facilities | Assisted Living Facility | 311500000X | N | Nursing & Custodial Care Facilities | Alzheimer Center (Dementia Center) | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 05 | KS | MEDICAID |