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General NPI Number Information
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NPI Number | 1679122865
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Entity Type | Organization
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Legal Business Name | SNH DERBY TENANT LLC
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 05/04/2020
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Provider Practice Location Address
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Address Line | 100 NEIGHBORLY WAY
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City | SOMERSET
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State | KY
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Zip | 42503-6147
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Country | US
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Telephone | 606-677-0166
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Fax | 606-677-0109
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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 OPERATING OFFICER
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Name | JENNIFER F. MINTZER
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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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