MEDICARE: 5 STAR RETIREMENT GROUP, CORP

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1538933239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	5 STAR RETIREMENT GROUP, CORP

Provider Business Mailing Address
First Line	:	1577 E QUINCY AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-2309
Country	:	US
Telephone Number	:	818-261-4887
Fax Number	:	559-484-2233

Provider Business Practice Location Address
First Line	:	1577 E QUINCY AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-2309
Country	:	US
Telephone Number	:	818-261-4887
Fax Number	:	559-484-2233

Authorized Official
Title or Position	:	CEO
Name	:	HASMIK JASMINE OGANYAN
Credential	:
Telephone Number	:	818-261-4887

Provider Enumeration Date	:	11/13/2023
Last Update Date	:	11/13/2023

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