Provider Demographics
NPI:1164079240
Name:SNH FLA TENANT LLC
Entity Type:Organization
Organization Name:SNH FLA TENANT LLC
Other - Org Name:PARK SUMMIT AT CORAL SPRINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:F
Authorized Official - Last Name:MINTZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-796-8350
Mailing Address - Street 1:255 WASHINGTON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1634
Mailing Address - Country:US
Mailing Address - Phone:617-796-8350
Mailing Address - Fax:
Practice Address - Street 1:8500 ROYAL PALM BLVD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5715
Practice Address - Country:US
Practice Address - Phone:954-752-9500
Practice Address - Fax:954-752-4413
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SNH FLA TENANT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-22
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid