Healthcare Provider Details

I. General information

NPI: 1982659819
Provider Name (Legal Business Name): FIVE STAR QUALITY CARE-AZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 S ARIZONA AVE
YUMA AZ
85364-8520
US

IV. Provider business mailing address

2470 S ARIZONA AVE
YUMA AZ
85364-8520
US

V. Phone/Fax

Practice location:
  • Phone: 928-344-8541
  • Fax: 928-344-0823
Mailing address:
  • Phone: 928-344-8541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCI369
License Number StateAZ

VIII. Authorized Official

Name: PAUL HOAGLAND
Title or Position: CFO
Credential:
Phone: 617-796-8292