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NPI Code Detail

MEDICARE: FIVE STAR QUALITY CARE - VA, LLC

MEDICARE: FIVE STAR QUALITY CARE - VA, 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
1310400000XAssisted Living FacilityFLO02004-569VA

General Provider Information

NPI Number : 1780626010
Entity Type Code : Organization
Provider Name (Legal Business Name) : FIVE STAR QUALITY CARE - VA, LLC
Provider Business Mailing Address
First Line : 400 CENTRE ST
Second Line :
City : NEWTON
State : MA
Zip : 02458-2094
Country : US
Telephone Number : 617-796-8387
Fax Number : 617-796-8385
Provider Business Practice Location Address
First Line : 2856 FOREHAND DR
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23323-2006
Country : US
Telephone Number : 757-487-9400
Fax Number : 757-487-7309
Authorized Official
Title or Position : PRESIDENT & CHIEF EXECUTIVE OFFICER
Name : BRUCE J MACKEY JR.
Credential :
Telephone Number : 617-796-8214
Provider Enumeration Date : 06/12/2006
Last Update Date : 06/27/2016

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