Provider Demographics
NPI:1447203641
Name:SNH SE TENANT TRS, INC
Entity Type:Organization
Organization Name:SNH SE TENANT TRS, INC
Other - Org Name:STRATFORD COURT OF PALM HARBOR
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 STREET
Mailing Address - Street 2:2 NEWTON PLACE
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458
Mailing Address - Country:US
Mailing Address - Phone:703-854-0823
Mailing Address - Fax:703-854-0164
Practice Address - Street 1:45 KATHERINE BLVD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3661
Practice Address - Country:US
Practice Address - Phone:949-581-6111
Practice Address - Fax:727-787-1506
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SNH SE TENANT TRS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
FL15250951314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0059400 00Medicaid
FL0059400 00Medicaid