Active NPI
FS Tenant Pool III Trust
- Skilled Nursing Facility
- Deerfield Beach, FL
National Provider Identifier
1508934829
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- FS TENANT POOL III TRUST
- Doing business as
- Forum at Deer Creek
- Practice address
- 3001 Deer Creek Country Club Blvd
Deerfield Beach, FL 33442-8438 - Phone
- (954) 698-6269
- Fax
- (954) 428-3074
- NPI assigned
- Dec 4, 2006
- Organization subpart
- Yes
- Parent organization
- FS TENANT POOL III TRUST
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Katherine E Potter
- Title
- President & Chief Executive Officer
- Phone
- (617) 796-8387
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | |||
| Skilled Nursing Facility | 314000000X | FL | Primary |
Addresses
Primary practice location
3001 Deer Creek Country Club Blvd
Deerfield Beach, FL 33442-8438
Mailing address
3001 Deer Creek Country Club Blvd
Deerfield Beach, FL 33442-8438
Phone (954) 698-6269
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SNF1162096 | Medicaid | FL | |
| 025348100 | Medicaid | FL |
Other names 1
- Forum at Deer Creek
National Provider Directory
National Provider Directory- Part of
- FS Tenant Pool III Trust
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165190400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1553644800000",
"number": "1508934829",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3001 DEER CREEK COUNTRY CLUB BLVD",
"city": "DEERFIELD BEACH",
"state": "FL",
"postal_code": "334428438",
"telephone_number": "954-698-6269",
"fax_number": "954-428-3074"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3001 DEER CREEK COUNTRY CLUB BLVD",
"city": "DEERFIELD BEACH",
"state": "FL",
"postal_code": "334428438",
"telephone_number": "954-698-6269",
"fax_number": "954-428-3074"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FS TENANT POOL III TRUST",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "FS TENANT POOL III TRUST",
"enumeration_date": "2006-12-04",
"last_updated": "2019-03-27",
"status": "A",
"authorized_official_last_name": "POTTER",
"authorized_official_first_name": "KATHERINE",
"authorized_official_middle_name": "E",
"authorized_official_title_or_position": "PRESIDENT & CHIEF EXECUTIVE OFFICER",
"authorized_official_telephone_number": "617-796-8387"
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": null,
"license": null,
"primary": false
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "FL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SNF1162096",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "025348100",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Forum at Deer Creek",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Forum at Deer Creek",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Deerfield Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.