Healthcare Provider Details

I. General information

NPI: 1780626010
Provider Name (Legal Business Name): FIVE STAR QUALITY CARE - VA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2856 FOREHAND DR
CHESAPEAKE VA
23323-2006
US

IV. Provider business mailing address

400 CENTRE ST
NEWTON MA
02458-2094
US

V. Phone/Fax

Practice location:
  • Phone: 757-487-9400
  • Fax: 757-487-7309
Mailing address:
  • Phone: 617-796-8387
  • Fax: 617-796-8385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberFLO02004-569
License Number StateVA

VIII. Authorized Official

Name: BRUCE J MACKEY JR.
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential:
Phone: 617-796-8214