MEDICARE: 5 STAR ADULT COMMUNITY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1043906852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	5 STAR ADULT COMMUNITY CENTER

Provider Business Mailing Address
First Line	:	8514 FOREST VALLEY DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-1104
Country	:	US
Telephone Number	:	513-223-4646
Fax Number	:

Provider Business Practice Location Address
First Line	:	8514 FOREST VALLEY DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-1104
Country	:	US
Telephone Number	:	513-223-4646
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CHERELLE BRUNIS
Credential	:	RN
Telephone Number	:	513-223-4646

Provider Enumeration Date	:	04/14/2023
Last Update Date	:	04/14/2023

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