Provider Demographics
NPI:1811626963
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 1:1590 W TIMBERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-1657
Mailing Address - Country:US
Mailing Address - Phone:765-662-9700
Mailing Address - Fax:765-662-9800
Practice Address - Street 1:1590 W TIMBERVIEW DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-1657
Practice Address - Country:US
Practice Address - Phone:765-662-9700
Practice Address - Fax:765-662-9800
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