Healthcare Provider Details

I. General information

NPI: 1740837749
Provider Name (Legal Business Name): SNH VIKING TENANT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20600 S DIAMOND LAKE RD
ROGERS MN
55374-4515
US

IV. Provider business mailing address

255 WASHINGTON ST STE 300
NEWTON MA
02458-1634
US

V. Phone/Fax

Practice location:
  • Phone: 763-428-1981
  • Fax: 463-428-3792
Mailing address:
  • Phone: 617-796-8350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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