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General NPI Number Information
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NPI Number | 1215666367
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Entity Type | Organization
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Legal Business Name | SNH INDY TENANT LLC
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Dates
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Enumeration Date | 06/06/2022
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Last Update Date | 06/06/2022
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Provider Practice Location Address
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Address Line | 603 SAINT JOSEPH DR
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City | KOKOMO
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State | IN
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Zip | 46901-4189
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Country | US
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Telephone | 765-868-3000
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Fax | 765-868-3084
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Provider Business Mailing Address
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Address Line | 603 SAINT JOSEPH DR
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City | KOKOMO
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State | IN
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Zip | 46901-4189
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Country | US
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Telephone | 765-868-3000
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Fax | 765-868-3084
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Authorized Official
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Title or Position | CFO & TREASURER
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Name | RICHARD W. SIEDEL JR.
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Credential |
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Telephone | 617-796-8350
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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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