Healthcare Provider Details

I. General information

NPI: 1215584685
Provider Name (Legal Business Name): SNH CAL TENANT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16915 HIERBA DR
SAN DIEGO CA
92128-2681
US

IV. Provider business mailing address

255 WASHINGTON ST STE 300
NEWTON MA
02458-1634
US

V. Phone/Fax

Practice location:
  • Phone: 858-673-6300
  • Fax: 858-673-6318
Mailing address:
  • Phone: 617-796-8350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER F. MINTZER
Title or Position: PRESIDENT & CHIEF OPERATING OFFICER
Credential:
Phone: 617-796-8350