Provider Demographics
NPI:1033900097
Name:POMPANO BEACH SLC TENANT LLC
Entity type:Organization
Organization Name:POMPANO BEACH SLC TENANT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:BILOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-796-8387
Mailing Address - Street 1:255 WASHINGTON ST STE 230
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1644
Mailing Address - Country:US
Mailing Address - Phone:617-796-8300
Mailing Address - Fax:
Practice Address - Street 1:1371 S OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-7130
Practice Address - Country:US
Practice Address - Phone:617-796-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DHC FM TRS HOLDCO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL126772800Medicaid