Provider Demographics
NPI:1558090605
Name:SNH INDY TENANT LLC
Entity Type:Organization
Organization Name:SNH INDY TENANT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO & TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:SIEDEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:617-796-8350
Mailing Address - Street 1:222 S 25TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-1800
Mailing Address - Country:US
Mailing Address - Phone:812-478-2400
Mailing Address - Fax:
Practice Address - Street 1:222 S 25TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-1800
Practice Address - Country:US
Practice Address - Phone:812-478-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility