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NPI Code Detail

MEDICARE: FIVE STAR CORAL SPRINGS LLC

MEDICARE: FIVE STAR CORAL SPRINGS LLC
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
1314000000XSkilled Nursing FacilitySNF1430095FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245279256
Entity Type Code : Organization
Provider Name (Legal Business Name) : FIVE STAR CORAL SPRINGS LLC
Provider Business Mailing Address
First Line : 8500 ROYAL PALM BLVD
Second Line :
City : CORAL SPRINGS
State : FL
Zip : 33065-5715
Country : US
Telephone Number : 954-752-9500
Fax Number : 954-755-9559
Provider Business Practice Location Address
First Line : 8500 ROYAL PALM BLVD
Second Line :
City : CORAL SPRINGS
State : FL
Zip : 33065-5715
Country : US
Telephone Number : 954-752-9500
Fax Number : 954-755-9559
Authorized Official
Title or Position : PRESIDENT & CHIEF EXECUTIVE OFFICER
Name : KATHERINE E POTTER
Credential :
Telephone Number : 617-796-8387
Provider Enumeration Date : 06/05/2006
Last Update Date : 03/28/2019

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Directions to “FIVE STAR CORAL SPRINGS LLC ” Practice Location

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