Provider Demographics
NPI:1669744413
Name:SNH SE SG TENANT LLC
Entity type:Organization
Organization Name:SNH SE SG TENANT LLC
Other - Org Name:<UNAVAIL>
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 STREET, SUITE 300
Mailing Address - Street 2:2 NEWTON PLACE
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-2076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 LAKE HUNTER CIRCLE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-5417
Practice Address - Country:US
Practice Address - Phone:843-388-2030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SNH SE SG TENANT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-08
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
425404Medicare Oscar/Certification