Healthcare Provider Details

I. General information

NPI: 1760591358
Provider Name (Legal Business Name): FIVE STAR QUALITY CARE FL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 NORTH COURSE DRIVE
POMPANO BEACH FL
33069-3058
US

IV. Provider business mailing address

2701 NORTH COURSE DRIVE
POMPANO BEACH FL
33069-3089
US

V. Phone/Fax

Practice location:
  • Phone: 954-975-8900
  • Fax: 954-975-8933
Mailing address:
  • Phone: 954-975-8900
  • Fax: 954-975-8933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number15550962
License Number StateFL

VIII. Authorized Official

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