Healthcare Provider Details

I. General information

NPI: 1619193471
Provider Name (Legal Business Name): FIVE STAR INVESTMENTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4026 S NC HIGHWAY 11
WALLACE NC
28466-6110
US

IV. Provider business mailing address

4026 S NC HIGHWAY 11
WALLACE NC
28466-6110
US

V. Phone/Fax

Practice location:
  • Phone: 910-285-5352
  • Fax:
Mailing address:
  • Phone: 910-285-5352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberHAL 031-010
License Number StateNC

VIII. Authorized Official

Name: NINA C. WILLIAMS
Title or Position: CO-OWNER
Credential:
Phone: 99102855352