Organization
SNH DERBY TENANT LLC
Active
Parent organization
SNH DERBY TENANT LLC
Other names
Lexington Country Place
Organization subpart
Yes
Provider details
NPI number
Legal business name
SNH DERBY TENANT LLC
Authorized official
JENNIFER F. MINTZER (PRESIDENT & CHIEF OPERATING OFFICER)
(617) 796-8350
Entity
Organization
Contact information
Practice address
700 MASON HEADLEY RD, LEXINGTON, KY 40504-2326
(859) 259-3486
(859) 276-2751
Mailing address
255 WASHINGTON ST STE 300, NEWTON, MA 02458-1634
(617) 796-8350
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
—
—
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
KY
Enumeration date
09/13/2019
Last updated
05/04/2020
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