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General NPI Number Information
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NPI Number | 1215585955
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Entity Type | Organization
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Legal Business Name | SNH WIS TENANT LLC
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Dates
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Enumeration Date | 08/27/2019
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 701 E PUETZ RD
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City | OAK CREEK
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State | WI
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Zip | 53154-3257
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Country | US
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Telephone | 414-766-2100
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Fax | 414-766-2200
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Provider Business Mailing Address
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Address Line | 255 WASHINGTON ST STE 300
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City | NEWTON
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State | MA
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Zip | 02458-1634
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Country | US
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Telephone | 617-796-8350
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CHIEF EXECUTIVE OFFICER
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Name | CHRISTOPHER J. BOLOTTO
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Credential |
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Telephone | 617-796-8387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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