Provider Demographics
NPI:1962467415
Name:FS TENANT POOL III TRUST
Entity type:Organization
Organization Name:FS TENANT POOL III TRUST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-796-8387
Mailing Address - Street 1:7831 PARK LANE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-2000
Mailing Address - Country:US
Mailing Address - Phone:214-369-9902
Mailing Address - Fax:214-373-1836
Practice Address - Street 1:7831 PARK LANE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-2000
Practice Address - Country:US
Practice Address - Phone:214-369-9902
Practice Address - Fax:214-373-1836
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FS TENANT POOL III TRUST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-19
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110390314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
455913Medicare Oscar/Certification
TX455913Medicare ID - Type Unspecified