Healthcare Provider Details

I. General information

NPI: 1417943028
Provider Name (Legal Business Name): FIVE STAR SAVANNAH SQUARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAVANNAH SQUARE DR
SAVANNAH GA
31406-6755
US

IV. Provider business mailing address

400 CENTRE ST
NEWTON MA
02458-2094
US

V. Phone/Fax

Practice location:
  • Phone: 912-927-7550
  • Fax: 912-921-8150
Mailing address:
  • Phone: 617-796-8387
  • Fax: 617-796-8375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10251158
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

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