Healthcare Provider Details

I. General information

NPI: 1447205117
Provider Name (Legal Business Name): FIVE STAR QUALITY CARE CA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6835 HAZELTINE AVE
VAN NUYS CA
91405-3218
US

IV. Provider business mailing address

400 CENTRE ST
NEWTON MA
02458-2094
US

V. Phone/Fax

Practice location:
  • Phone: 818-997-1841
  • Fax: 818-893-6815
Mailing address:
  • Phone: 617-796-8387
  • Fax: 617-796-8375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number920000087
License Number StateCA

VIII. Authorized Official

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