Healthcare Provider Details

I. General information

NPI: 1639125032
Provider Name (Legal Business Name): FIVE STAR QUALITY CARE-NE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 MAPLE ST
SUTHERLAND NE
69165-3000
US

IV. Provider business mailing address

PO BOX 307 333 MAPLE STREET
SUTHERLAND NE
69165-3000
US

V. Phone/Fax

Practice location:
  • Phone: 308-386-4393
  • Fax: 308-386-4378
Mailing address:
  • Phone: 308-386-4393
  • Fax: 308-386-4378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number514004
License Number StateNE

VIII. Authorized Official

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