MEDICARE: SNH NJ TENANT LLC

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
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1407404015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SNH NJ TENANT LLC

Provider Business Mailing Address
First Line	:	255 WASHINGTON ST STE 300
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02458-1634
Country	:	US
Telephone Number	:	617-796-8350
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 ROUTE 70
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5949
Country	:	US
Telephone Number	:	732-370-0444
Fax Number	:	732-370-1783

Authorized Official
Title or Position	:	PRESIDENT & CHIEF OPERATING OFFICER
Name	:	JENNIFER F. MINTZER
Credential	:
Telephone Number	:	617-796-8350

Provider Enumeration Date	:	08/27/2019
Last Update Date	:	05/07/2020

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