Provider Demographics
NPI:1518518521
Name:SNH WY TENANT LLC
Entity Type:Organization
Organization Name:SNH WY TENANT LLC
Other - Org Name:
Other - Org Type:
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 1:1901 HOWELL AVE
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-3733
Practice Address - Country:US
Practice Address - Phone:307-347-4285
Practice Address - Fax:307-347-2154
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SNH WY TENANT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-23
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYPENDINGMedicaid