Healthcare Provider Details

I. General information

NPI: 1780487587
Provider Name (Legal Business Name): FIVE STAR COMMUNITY RESOURCE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 N 24TH ST
MILWAUKEE WI
53205-1408
US

IV. Provider business mailing address

1710 N 24TH ST
MILWAUKEE WI
53205-1408
US

V. Phone/Fax

Practice location:
  • Phone: 414-344-9433
  • Fax: 414-344-9266
Mailing address:
  • Phone: 414-344-9433
  • Fax: 414-344-9266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AKYAA SMITH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 414-344-9433