Healthcare Provider Details

I. General information

NPI: 1972003218
Provider Name (Legal Business Name): FIVE STAR QUALITY CARE-COLORADO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 S MAIN ST
DELTA CO
81416-2407
US

IV. Provider business mailing address

2050 S MAIN ST
DELTA CO
81416-2407
US

V. Phone/Fax

Practice location:
  • Phone: 970-874-9773
  • Fax: 970-874-3611
Mailing address:
  • Phone: 970-874-9773
  • Fax: 970-874-3611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateCO

VIII. Authorized Official

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