Healthcare Provider Details

I. General information

NPI: 1043265325
Provider Name (Legal Business Name): FIVE STAR QUALITY CARE-KS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 W 7TH ST
ELLINWOOD KS
67526-1101
US

IV. Provider business mailing address

400 CENTRE ST
NEWTON MA
02458-2094
US

V. Phone/Fax

Practice location:
  • Phone: 620-564-2337
  • Fax: 620-564-3527
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 NumberN005004
License Number StateKS

VIII. Authorized Official

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