Healthcare Provider Details

I. General information

NPI: 1154978260
Provider Name (Legal Business Name): SNH NM TENANT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 ACADEMY RD NE
ALBUQUERQUE NM
87111-7306
US

IV. Provider business mailing address

255 WASHINGTON ST STE 300
NEWTON MA
02458-1634
US

V. Phone/Fax

Practice location:
  • Phone: 505-294-9944
  • Fax: 505-294-1808
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