# FS LEISURE PARK TENANT TRUST

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** FS LEISURE PARK TENANT TRUST
- **Other names:** Leisure Park Health Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1861560187
- **Legal business name:** FS LEISURE PARK TENANT TRUST
- **Authorized official:** KATHERINE E POTTER (PRESIDENT & CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (617) 796-8387

## Contact information

- **Practice address:** 1400 HIGHWAY 70, LAKEWOOD, NJ 08701-5949
- **Practice address phone:** (732) 370-0444
- **Practice address fax:** (732) 370-1783
- **Mailing address:** 1400 HIGHWAY 70, LAKEWOOD, NJ 08701-5949
- **Mailing address phone:** (732) 370-0444
- **Mailing address fax:** (732) 370-1783

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | — | — | — |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 12/04/2006
- **Last updated:** 03/26/2019