Provider Demographics
NPI:1851450084
Name:FS TENANT POOL I TRUST
Entity Type:Organization
Organization Name:FS TENANT POOL I TRUST
Other - Org Name:THE MONTEVISTA AT CORONADO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-796-8387
Mailing Address - Street 1:1575 BELVIDERE ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2649
Mailing Address - Country:US
Mailing Address - Phone:915-833-2229
Mailing Address - Fax:915-581-6168
Practice Address - Street 1:1575 BELVIDERE ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-2649
Practice Address - Country:US
Practice Address - Phone:915-833-2229
Practice Address - Fax:915-581-6168
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FS TENANT POOL I TRUST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-06
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
455705Medicare Oscar/Certification