Basic Information
| Provider Information | |||||||||
| NPI: | 1730477399 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SNH SE TENANT TRS, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SUMMIT PLACE OF SOUTHPARK | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 NEWTON PL | ||||||||
| Address2: | 255 WASHINGTON STREET, SUITE 300 | ||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024581637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177968350 | ||||||||
| FaxNumber: | 6177968349 | ||||||||
| Practice Location | |||||||||
| Address1: | 2101 RUNNYMEDE LN | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282093316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045255508 | ||||||||
| FaxNumber: | 7045252672 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2011 | ||||||||
| LastUpdateDate: | 04/30/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MINTZER | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6177968350 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SNH SE TENANT TRS, INC | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | HAL-060-116 | NC | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.