Healthcare Provider Details

I. General information

NPI: 1306461892
Provider Name (Legal Business Name): FIVE STAR QUALITY HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8460 LIMEKILN PIKE APT 715
WYNCOTE PA
19095-2629
US

IV. Provider business mailing address

8460 LIMEKILN PIKE APT 715
WYNCOTE PA
19095-2629
US

V. Phone/Fax

Practice location:
  • Phone: 267-235-4000
  • Fax:
Mailing address:
  • Phone: 267-235-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SHIKEETA HERRING
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 267-235-4000