MEDICARE: FS TENANT POOL I 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
1	314000000X	Skilled Nursing Facility	NCF829	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841245313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FS TENANT POOL I TRUST

Provider Business Mailing Address
First Line	:	9547 HIGHWAY 17 NORTH
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-4039
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9547 HIGHWAY 17 NORTH
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-4039
Country	:	US
Telephone Number	:	843-449-5283
Fax Number	:	843-497-0880

Authorized Official
Title or Position	:	PRESIDENT & CHIEF EXECUTIVE OFFICER
Name	:	KATHERINE E POTTER
Credential	:
Telephone Number	:	617-796-8387

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	03/27/2019

Similar Medicare Providers

1598312886 — SNH SC TENANT LLC
Practice Location Address:

9547 N KINGS HWY
MYRTLE BEACH, SC
29572-4039

Practice Phone: 843-449-5283
Practice Fax: 843-497-0880

1508677154 — MRS. AUTUMN ROSE HANN AGNP-C
Practice Location Address:

9547 N KINGS HWY
MYRTLE BEACH, SC
29572-4039

Practice Phone: 843-429-8465
Practice Fax:

1407033509 — CAROLYN IRENE DEWANE RD,LD
Practice Location Address:

253 SEAMIST CT
PONTE VEDRA BEACH, FL
32082-4039

Practice Phone: 904-610-1640
Practice Fax:

1578850814 — H M SIMKIN, OD, PA
Practice Location Address:

209 ROYAL POINCIANA WAY
PALM BEACH, FL
33480-4039

Practice Phone: 561-802-6266
Practice Fax: 561-802-6268

1154831873 — SANDY HANNA
Practice Location Address:

6301 BEACH BLVD STE 105
BUENA PARK, CA
90621-4039

Practice Phone: 714-690-0349
Practice Fax:

1124865159 — MRS. LAUREN JENNA MAGUIRE RD, CDCES
Practice Location Address:

329 W FARMINGTON RD
VIRGINIA BEACH, VA
23454-4039

Practice Phone: 908-247-1408
Practice Fax:

Directions to “FS TENANT POOL I TRUST ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.