MEDICARE: FIVE STAR QUALITY CARE- NORTH CAROLINA, 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
1	311500000X	Alzheimer Center (Dementia Center)	HAL-060-055	NC
2	311500000X	Alzheimer Center (Dementia Center)

General Provider Information

NPI Number	:	1326291121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIVE STAR QUALITY CARE- NORTH CAROLINA, LLC

Provider Business Mailing Address
First Line	:	400 CENTRE STREET
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02458
Country	:	US
Telephone Number	:	617-796-8160
Fax Number	:	617-796-8375

Provider Business Practice Location Address
First Line	:	6101 CLARKE CREEK PARKWAY
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-6238
Country	:	US
Telephone Number	:	704-947-8050
Fax Number	:	704-992-1560

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	PAUL HOAGLAND
Credential	:
Telephone Number	:	617-796-8292

Provider Enumeration Date	:	10/24/2008
Last Update Date	:	04/01/2010

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