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NPI Code Detail

MEDICARE: FS TENANT POOL III TRUST

MEDICARE: FS TENANT POOL III TRUST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1310400000XAssisted Living Facility
2314000000XSkilled Nursing Facility6110OH
3314000000XSkilled Nursing Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000249676OTHEROHANTHEM BLUE CROSS BLUE SH

General Provider Information

NPI Number : 1154386605
Entity Type Code : Organization
Provider Name (Legal Business Name) : FS TENANT POOL III TRUST
Provider Business Mailing Address
First Line : 400 CENTRE STREET
Second Line :
City : NEWTON
State : MA
Zip : 02458
Country : US
Telephone Number : 617-796-8160
Fax Number : 617-796-8375
Provider Business Practice Location Address
First Line : 4590 KNIGHTSBRIDGE BLVD
Second Line :
City : COLUMBUS
State : OH
Zip : 43214-4327
Country : US
Telephone Number : 614-451-6793
Fax Number : 614-273-2450
Authorized Official
Title or Position : PRESIDENT & CHIEF EXECUTIVE OFFICER
Name : KATHERINE E POTTER
Credential :
Telephone Number : 617-796-8387
Provider Enumeration Date : 04/19/2006
Last Update Date : 03/27/2019

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Directions to “FS TENANT POOL III TRUST ” Practice Location

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