=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508821059
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FS TENANT POOL III TRUST
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2006
-----------------------------------------------------
Last Update Date | 03/27/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 777 NORTH POST OAK ROAD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-956-0732
-----------------------------------------------------
Fax | 713-956-0732
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 CENTRE STREET
-----------------------------------------------------
City | NEWTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-796-8160
-----------------------------------------------------
Fax | 617-796-8375
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESDIENT & CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | KATHERINE E POTTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 617-796-8387
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 110072
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------