Provider Demographics
NPI:1104565381
Name:SNH TELLICO TENANT LLC
Entity type:Organization
Organization Name:SNH TELLICO TENANT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.F.O. & TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:SIEDEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:617-796-8350
Mailing Address - Street 1:100 CHATUGA DR W
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-2786
Mailing Address - Country:US
Mailing Address - Phone:865-408-0211
Mailing Address - Fax:865-408-1288
Practice Address - Street 1:100 CHATUGA DR W
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-2786
Practice Address - Country:US
Practice Address - Phone:865-408-0211
Practice Address - Fax:865-408-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility