Healthcare Provider Details

I. General information

NPI: 1134174501
Provider Name (Legal Business Name): FIVE STAR QUALITY CARE-CA II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 WEST AVENIDA DE LOS ARBOLES
THOUSAND OAKS CA
91360-2900
US

IV. Provider business mailing address

93 WEST AVENIDA DE LOS ARBOLES
THOUSAND OAKS CA
91360-2900
US

V. Phone/Fax

Practice location:
  • Phone: 805-492-2444
  • Fax: 805-241-8925
Mailing address:
  • Phone: 805-492-2444
  • Fax: 805-241-8925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number05000065
License Number StateCA

VIII. Authorized Official

Name: KATHERINE E. POTTER
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential:
Phone: 617-796-8387